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Obstetrics and Gynecology Schedule and Requirements

During each of their four years, all residents spend two months of the year on a night float rotation. During this rotation, while under the supervision of full-time attending physicians, residents manage obstetrical patients, emergency room visits, and emergency surgery appropriate to their level of training. The night float rotation permits residents to avoid the disruption to their day-to-day rotations that would result from having to take night call. This allows them to be present each day to provide continuous care in the educational activities of each rotation. During each year of training, residents hold regular weekly office sessions, to which patients can be referred.

During this experience, residents receive intensive training in medical interviewing and patient communication. Patient scheduling is spaced to allow sufficient time for residents to develop the essential skills needed to be excellent primary care physicians. Residents receive training in prenatal care and outpatient gynecological management, as well as the psychological aspects of patient care, counseling, and education. Common general medical problems seen in the office setting are all covered extensively. If the resident's patients require surgery or in-house obstetrical care, the resident participates in that care, thus ensuring continuity.

PGY 1 PGY 2 PGY 3 PGY 4
Subspecialty
4 weeks
Obstetrics
12 weeks
Gynecology
14 weeks
Gynecology
12 weeks
Anesthesia
2 weeks
GYN ER Nights
8 weeks
Obstetrics
14 weeks
Gynecological Oncology
12 weeks
Obstetrics
20 weeks
Subspecialty
8 weeks
REI
8 weeks
Obstetrics
12 weeks
Obstetrics Nights
10 weeks
Gynecology
12 weeks
MFM
8 weeks
Obs/GYN Nights
8 weeks
Gynecology
16 weeks
SICU
4 weeks
Obs/GYN Nights
8 weeks
Ambulatory Clinic
4 weeks
  Oncology
8 weeks
   

CONTENT:

First year (PGY 1)
On the obstetrical service, residents develop skills in the management of obstetrical patients on labor and delivery. During that time they receive instruction in electronic fetal monitoring. As they progress through their rotation, residents become more involved in performing operative obstetrical procedures. Residents are also taught the use of obstetrical ultrasound. During this rotation residents cover the postpartum service where they develop skills in postpartum care.

On the gynecology service, the resident learns the pre-operative and post-operative care of gynecologic inpatients. Residents develop skills in the diagnosis and management of a broad range of gynecologic conditions and in operative gynecology by assisting in the operating room on major surgical procedures and by performing minor operative procedures.

Each resident spends four weeks in a specialized rotation. They learn obstetrical and gynecologic ultrasound in the department's specialized Antepartum Testing Unit under the direct supervision of the full-time maternal-fetal medicine faculty and ultrasound specialist. The residents are instructed in performing ultrasound scans, perform scans themselves and then review their findings with the faculty. They have an opportunity to develop both basic and advanced skills, including transvaginal sonography and amniocentesis. Time is also spent with the neonatologists on the labor and delivery unit, allowing the resident to learn the principles of, and to gain experience in, neonatal resuscitation.

Finally, two months are spent on the night float rotation, where the resident works closely, one on one, with the senior resident and a full-time faculty member and manages all obstetrical patients presenting to Labor and Delivery. It is on this rotation that residents have the greatest opportunity to develop confidence in their skills as obstetricians.

Throughout the year, except while on night float, all residents rotate to the Outpatient Department one day a week. This helps fulfill their continuity clinic requirements as well as their ambulatory primary care requirements. By taking the unique approach of spreading the resident's primary care experience over four years of their training rather than as a block rotation, we are able to improve their learning experience and avoid having residents spend extended periods of time away from their desired focus on obstetrics and gynecology. From the start, the first year resident begins to develop a panel of patients that they will continue to see throughout the next four years of their training. [ top ]

Second Year (PGY 2)
On the obstetrical service, residents assume progressive responsibility acquiring skills for operative vaginal deliveries and performing the more difficult cesarean sections. The residents are responsible for the post-operative care of all the patients under the direction of our full-time faculty. They also assist in the management of the high-risk obstetrical service.

On the gynecology service, progressive responsibilities are assumed in the operating room. Residents become involved in more difficult cases, including operative laparoscopies and non-complicated hysterectomies, and manage their patients' post-operative care.

Our residents experience a combined specialty rotation, with training in both outpatient management and operative experience in reproductive endocrinology, and outpatient management of High Risk Obstetrics, urogynecology, and colposcopy. (This rotation is repeated in the third year of training.) Residents care for all patients on the reproductive endocrinology/infertility service and participate in all operative procedures. On this service, they develop and polish their skills in microsurgery, gynecologic endoscopy and laparoscopy. They also rotate to the outpatient endocrinology service and laboratory and participate in the IVF/GIFT programs. Twice a week, residents attend the High Risk Obstetrics clinic, where they learn to manage pregnancies complicated by both obstetric and medical disorders. Once a week, residents attend the urogynecology clinic, where they learn about urogynecological evaluation of patients, including urodynamic testing, cystoscopy/urethroscopy and ambulatory management of urogynecologic problems. Residents also attend the colposcopy clinic weekly, where they learn about the management of women with abnormal Pap smears and develop the pattern recognition skills required for this specialty.

Two months are spent on the gynecologic oncology service under the supervision of the Chief Resident and our board certified gynecologic oncologists. Residents participate in the pre-operative, surgical and post-operative care of all gynecologic oncology patients within the division. They learn the basics of radiation oncology and chemotherapy and assist with difficult and advanced laparotomies. Residents also attend the colposcopy and gynecologic oncology clinics weekly, where they learn about the management of women with cancer and abnormal Pap smears and develop the pattern recognition skills required for this specialty.

One month is spent on rotation in the Surgical Intensive Care Unit under the direction of our surgical intensivists. This rotation provides exposure to post-operative critically ill patients and conditions involving fluid and electrolyte imbalances and respiratory and cardiac complications. During this rotation the residents care for both general surgery and obstetric and gynecologic critically ill patients and receive training in invasive line placement and ventilation management.

Finally, two months are spent on the night float rotation, where the resident acts as a gynecologic consultant to the Emergency Department under the direct supervision of the on-call attending physician. The resident performs all emergency gynecologic surgical procedures that present at night, including operative laparoscopies.

Residents also continue their Ob/Gyn continuity clinic experience. As their experience and knowledge grows, the cases the resident sees increase in both number and complexity. When the resident's patients require hospitalization, the resident participates in the inpatient care, providing the necessary continuity. [ top ]

Third Year (PGY 3)
During this year the resident is provided with the opportunity to care for a larger caseload, as well as increased responsibility as part of the team caring for patients with more complex problems. Third year residents have even more responsibility in case preparation and presentation, and a more significant involvement in educational programs for their fellow residents, students, patients, and the community. They also assume increased responsibility for the psychosocial aspects of patient care.

On the obstetrical service, the third year resident is directly involved in the clinical management of all the patients on the labor floor under the supervision of the chief resident and the attending physician. In certain months, the third year resident replaces the fourth year resident and acts as the chief of the service. During this rotation, the third year resident also becomes an integral member of the high-risk obstetrics team. The resident admits and cares for patients with medical and obstetrical complications of pregnancy and is supervised by the department's board-certified MFM specialists.

Two months are spent on the Maternal Fetal Medicine service under the direct supervision of our Maternal Fetal Medicine specialists. During this rotation the resident admits and cares for patients with medical and obstetrical complications of pregnancy along with the Chief Resident and MFM specialists. In addition further time is spent at the Advanced Womens Imaging and Prenatal Testing Center at which further experience is gained in antepartum surveillance, genetic counseling as well as ob/gyn ultrasound and amniocentesis.

Five weeks are spent on the gynecologic oncology service under the supervision of the Chief Resident and our board certified gynecologic oncologists. Residents participate in the pre-operative, surgical and post-operative care of all gynecologic oncology patients within the division. They learn the basics of radiation oncology and chemotherapy and assist difficult and advanced laparotomies. Residents also attend the colposcopy and gynecologic oncology clinics weekly, where they learn about the management of women with cancer and abnormal Pap smears and develop the pattern recognition skills required for this specialty.

On the gynecology service, third year residents perform major gynecologic surgery, including difficult hysterectomies and major operative laparoscopies. Along with the junior residents on that team, they are also responsible for pre-operative and post-operative management of all patients on this service. Similarly to the obstetric service, in certain months, the third year resident replaces the fourth year resident and acts as the chief of the service.

Third year residents repeat their experience on the combined specialty rotation in reproductive endocrinology, outpatient high-risk obstetrics, urogynecology, and colposcopy. By repeating this rotation at a time when they have greater experience and maturity in the specialty, they are able to not only reinforce the lessons and skills that they learned the year before but to build on them.

Finally, two months are spent on the night float rotation, where the resident has the opportunity to individually manage the labor floor as the most senior resident under the supervision of the in-house faculty-attending physician. It is in this rotation, specifically, that residents solidify their skills as obstetricians and develop their confidence as team leaders.

Regular office hours established during the first two years of training continue to be held in the third year. Indeed, third year residents play an increasing role as primary care physicians for their patients. The residents have the opportunity to practice their primary care skills in an Ob/Gyn setting that will be reflected in their practice in future years. [ top ]

Fourth Year (Chief Resident PGY 4)
Three months are spent on the gynecologic oncology service under the supervision of our board certified gynecologic oncologists. Residents participate in the pre-operative, surgical and post-operative care of all gynecologic oncology patients within the division. They learn the basics of radiation oncology and chemotherapy and perform difficult and advanced laparotomies, perfecting their surgical skills prior to their graduation. Residents also attend the colposcopy weekly, where they learn about the management of women with abnormal Pap smears and develop the pattern recognition skills required for this specialty.

Three months are spent as chief resident in gynecology. Residents on this rotation perform advanced surgical procedures including vaginal and urogynecologic procedures, difficult and advanced abdominal procedures and operative laparoscopies. They are responsible for the management of their services, including the supervision and teaching of junior residents and medical students and the presentation of cases in all formal rounds with the gynecological attending staff.

Three months are spent as obstetrical chief resident, when the resident is responsible for all routine and high-risk patients on the obstetrical service. The resident is also responsible for training junior residents and medical students in obstetrics. Chief residents are considered junior faculty members and assume responsibilities appropriate for that rank.

Residents continue their Ob/Gyn Continuity Clinic experience with an additional one-month clinic assignment. During this experience, the Chief Resident will serve as a Junior Attending and oversee and teach junior residents and medical students thereby further preparing them for life after residency as an independent obstetrician gynecologist.

Finally, two months are spent on the night float rotation, where the resident continues the responsibility of chief resident to supervise the management of all patients on Labor and Delivery and on the gynecological service. The chief residents assist and teach the junior residents in the management of both obstetrical patients on Labor and Delivery and gynecological patients in the Emergency Department and on the gynecology service. [ top ]

Additional Features

  • Annual in-service exam of CREOG
  • Residents choose a topic for a research project early in their second year. (A faculty member supervises this work.) They write and present at least one paper on Visiting Professor's Day in the fourth year. Projects this year include:
    • Sickle cell trait and pregnancy outcome
    • First trimester maternal serum PAPP A with normotensive and pre-eclamptic in African American women
    • "Vaginal irrigation with chlorhexidine for the prevention of peripartal infection: A randomized clinical trial"
    • Recurrent pre-eclampsia: identification of risk factors
  • As a matter of policy, there are no fellowships in the subspecialties of maternal fetal medicine, oncology, urogynecology, and reproductive endocrinology. We believe that fellowship programs direct the management of more interesting and complex cases towards their fellows, thereby depriving their residents of the opportunity to learn from managing patients in these specialty areas more directly.
  • In addition to the residents, the department employs physician assistants, and midwives for both the obstetrics and gynecology service. These individuals work closely with the resident staff and are supervised by the resident staff. Their primary roles are to improve clinical care and reduce the clinical burden of the non-teaching activities of the residents.
  • Residents are assigned to hospital-wide committees, such as the Graduate Medical Education Committee and the Quality Improvement Committee. Residents' contributions are an integral part of the function of these committees. [ top ]

Conference Schedule and Lectures
Lecture and Conference time is protected time for the residents. With the help of physician assistants, midwives, and attending physicians residents are freed from routine duties in order to participate fully in the teaching program.

Grand Rounds
Attendance of all residents is required. Grand rounds are scheduled on Wednesday mornings for one hour from September through June and are held in the Hospital auditorium. Speakers include many nationally prominent authorities in the field of obstetrics and gynecology.

Gynecology Morbidity and Mortality Conference
Recent cases of high educational value are presented by the chief residents and discussed. This meeting is scheduled for the second and fourth Wednesday of each month, prior to grand rounds.

Obstetrical Morbidity and Mortality Conference
Recent cases of high educational value are presented by the chief residents and discussed. This meeting is scheduled for the first and third Wednesday of each month, prior to grand rounds.

Ambulatory Morbidity and Mortality Conference
This conference is held the fifth Wednesday of the month, when applicable. Relevant educational cases from the outpatient continuity clinic are presented by the residents and discussed.

Resident Lecture Series
A series of lectures in each of the five disciplines of Ob/Gyn and primary care is held monthly on a rotating basis on Tuesday from 7:00 to 9:00 a.m. and on Wednesday from 10:00 to 12:00 noon. These lectures are specifically designed for residents. The sequence of lectures is repeated on a two-year cycle. Speakers for these lectures include department and hospital-wide faculty members as well as guest speakers.

Included as part of this series is Life Long Learning which is an article review on current topics as well as self-testing manuals offered by the Foundation for Excellence; Chief Resident-run review series as well as onsite skills training with inanimate simulation centers.

Pediatrics/Obstetrics Perinatal Case Conference
This conference is held jointly with Pediatrics for one hour on the second Tuesday of each month. The residents present an educational case with a neonatologist and a perinatologist leading the discussion.

Proficiency Exams and Review Sessions
Periodically, all residents are given a formal one-hour test followed by a one-hour review session. The tests are an opportunity to both review and solidify the didactic information recently taught. Topics are assigned based on lectures given over the previous weeks.

Ob/Gyn Journal Club
Thematic journal club meetings are scheduled periodically. The articles and topic are selected by the supervising faculty member and the department's research director. Individual residents are assigned to review and present the articles and the supervising faculty member leads the discussion.

Tumor Board
This meeting is scheduled as the first Grand Rounds on the first Wednesday of each month. The meeting is attended by a pathologist and radiation oncologist and chaired by the director of gynecologic oncology.

Dysplasia Correlation Conference
An attending physician presents this hour-long lecture series once a month. Colposcopic slides are presented for discussion.

Medical Jurisprudence Conference
This conference is given on the fifth Wednesday of the month, when applicable. Medicolegal issues pertinent to the Ob/Gyn specialty are presented and discussed by various guest attorneys in conjunction with the Risk Management Department of the Hospital.

New York Obstetrical and Brooklyn Gynecological Societies
Residents are invited monthly to attend these meetings, which feature nationally prominent speakers. The department assumes all costs. [ top ]


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