Obstetrics and gynecology residency

Includes supervising laboring patients, teaching other residents as well as medical students, gaining experience in advanced surgical skills, gynecologic pathology, colposcopy and robotic surgery. Managing your own patients in our continuity care clinic for four years.

Additional areas of focus include:

• Research
• Ultrasound
• Breast disease
• Menopause education
• Family planning education
• NICU education
• Minimally Invasive Gynecologic Surgery

Our residents have always had the opportunity to improve the quality of their education through feedback and suggestion–this will never change. Neither will the excellence towards education from dedicated teaching staff.

Between the two hospitals, approximately 10,000 obstetric deliveries take place annually (Corewell Health Butterworth Hospital (part of Corewell Health Grand Rapids Hospitals) 7,500+, Saint Mary’s Hospital 2,500+). About a third of these obstetric deliveries are residency practice patients whose care is provided by the resident under the supervision of core faculty members. The other obstetric patients are private patients of obstetricians throughout the city who residents also have the opportunity to care for. The patient population includes normal obstetric patients and high-risk patients referred to sub-specialists in maternal-fetal medicine. Our resident clinic is the largest in the state, with our residents delivering approximately 1,700 patients per year.

A full range of high-risk problems are seen routinely during the four years of residency. Common high-risk problems include:

• Multiple gestations
• Metabolic disorders
• Hypertensive disease of pregnancy
• Hemoglobinopathies
• Substance abuse

Our faculty has six board certified sub-specialists in maternal medicine. The residents will spend one rotation in R1, R2, and R3 on the high-risk obstetric service, at the Spectrum Health campus. The regional neonatal intensive care unit is located at Helen DeVos Children’s Hospital and this generates a large volume of transferred high-risk patients from all over western Michigan.

In the first year, residents will be on this service for four weeks, as well as six weeks in the second and third years. While on the perinatal service, the residents manage high-risk patients on the antepartum ward, in labor and delivery, the post-partum ward and in the intensive care unit. They also learn the techniques of ultrasonography and genetic amniocentesis. They participate in genetics counseling and assist with CVS and PUBS procedures. Mercy Health Saint Mary’s Hospital also has a level 3 special care nursery staffed by board certified neonatologists. Therefore, our residents are exposed to an ample volume of complicated obstetric patients. Spectrum Health has a high risk clinic. There is an educational and working conference that is associated with each clinic session. The perinatologists supervise these clinics and conferences.

Throughout the four years, residents also attend a variety of didactic teaching conferences. Obstetric Morbidity and Mortality Improvement (MMI) conferences are presented at each hospital on a monthly basis. There is a multi-specialty fetal anomaly conference once a month and perinatologists give lectures every month. Weekly neonatal rounds take place at Corewell Health Butterworth Hospital (part of Corewell Health Grand Rapids Hospitals).

Genetics is primarily learned during the rotation on maternal fetal medicine perinatology in the first year. While on this rotation, residents participate in genetic counseling and diagnostic procedures. While on the Corewell Health Butterworth Hospital (part of Corewell Health Grand Rapids Hospitals) rotation, the residents work closely with a genetics counselor.

Residents develop their skills with prenatal genetic testing and counseling in their own continuity clinics. When the patient requires consultation with a perinatologist, the resident is able to follow their patient and stay involved in the evaluation process. There is a monthly fetal board that is multi-disciplined and includes participants from the genetics department. Didactic lectures are also presented to the residents on genetic topics.

The genetics department has also created a two year didactic curriculum which is part of our weekly didactics. These lectures are given by leaders in genetics and cover the depths of knowledge expected of the practicing obstetrician and gynecologist.

Although many patients come from private attendings, residents participate actively in the management and therapeutic decisions of all complicated obstetric patients. As a resident, you will gain experience in normal obstetrics in each of the four years. The first and second years receive the greatest exposure to obstetrics. In the first year, the resident spends six months covering labor and delivery. The second year residents similarly cover labor and delivery for 18 weeks during the day, but they also cover labor and delivery for 12 weeks in a “night float” system. In the third year, residents spend six weeks on obstetrics. In the fourth year, each resident spends six weeks as the chief of obstetrics.

Supervision is provided, in house, 24 hours a day by our core faculty. Starting in the first year, each resident has obstetric patients included in their own personal continuity clinic. In this clinic setting, they provide prenatal care under the supervision of upper level residents and an attending physician.

All residents are expected to attend morning and night report for either obstetrics or gynecology each day wherever assigned. At this conference, the management of labor and delivery patients or gynecology patients is reviewed with the chief resident as well as an attending and treatment plans are generated.

During the obstetrics rotation, residents learn the mechanics of spontaneous and operative delivery under the supervision of more senior residents and the attending faculty. They learn how to use forceps, the vacuum extractor, and how to perform cesarean sections. They are also responsible for post-partum care and the management of complications.

Vaginal delivery after cesarean section is encouraged, and residents have a sound experience in managing and delivering these patients. Residents learn the technique of external cephalic version of a breech presentation. Vaginal breech deliveries are allowed in appropriate patients, and the residents are actively involved. Topics in normal obstetrics are also presented in didactic lectures, grand rounds, obstetrical MMI conferences and at morning report.

Formal instruction in ultrasound techniques is obtained in several different areas. In the first year, the residents have a four or two week ultrasound rotation working with maternal fetal medicine. In the third year, the residents learn how to perform vaginal probe ultrasound from reproductive endocrinologists. In the second and third year, the residents spend another six weeks on maternal fetal medicine where they get additional training in ultrasound.

Each labor and delivery unit has a portable ultrasound unit provided for resident use on a continuous basis. Residents perform their own scans on laboring and prenatal patients as needed. Upper level residents and the attending faculty supervise the lower level residents. Residents average approximately 150 vaginal probe ultrasounds with a much higher number of abdominal scans during their four years of training.

The experience in operative gynecology is gained at each hospital during the entire residency. It increases incrementally as the resident progresses through the four years. Even in the first year, the resident is assigned to a formal rotation on the gynecologic service, assisting in cases such as: endometrial ablations, hysteroscopy, laparoscopic tubal ligations, and dilation and curettages.

In the second year, each resident spends six weeks on the gynecology service. During this time, they learn to do routine pre- and post-operative care. They also learn more advanced procedures, such as operative hysteroscopy, laparoscopies, and sterilizations.

During the third year, the resident concentrates primarily on gynecology, spending 12 weeks on the gynecology service, six weeks on reproductive endocrinology and six weeks on urogynecology. During this year, the residents become involved in complicated pre- and post-operative care, performing abdominal and vaginal hysterectomies, exploratory laparotomies, operative hysteroscopy and laparoscopies, and pelvic prolapse repairs. The reproductive technologies, including GIFT, ZIFT, IVF, micro-surgical techniques and the use of LASER modalities are taught. The resident is usually the operating surgeon and the attending faculty assists them. To help our residents develop surgical techniques and to become more adept at delicate surgery, we utilize simulation labs.

In the last year, each chief resident receives surgical experience from the gynecologic service as well as administrative duties to assign surgical cases. They receive further surgical experience during the gynecologic oncology service and urogynecology. They assume responsibility for all aspects of operative gynecology, as well as becoming involved in teaching other residents. The level of supervision is commensurate with the level of expertise the resident has developed to that point.

The experience in advanced laparoscopy and robotic surgery is gained in a fourth year of training during six weeks of MIGS rotation. During this rotation chief residents master their conventional laparoscopy skills and advance their robotic experience with complex gynecological cases including symptomatic large fibroids, stage four endometriosis, repair of incompetent cesarean section scar, complex adnexal masses etc. At the same time, residents on this rotation gain exposure to conservative management of symptomatic fibroids, endometriosis, chronic pelvic pain, and vaginal and vulvar dysplasia. Twice a month, MIGS faculty runs residents complex gynecology clinic on a base of residency continuity clinic.

In the third year, the resident spends six-weeks on the reproductive endocrinology service. While on this rotation, the resident becomes actively involved in the evaluation and management of infertility patients. They become skilled at managing clomiphene citrate therapy, and they learn the principles of gonadotropin stimulation. They also learn about the more advanced technologies and participate in the GIFT, ZIFT, and IVF procedures. Subspecialists give reproductive endocrinology and infertility lectures monthly.

All of our urogynecologists are board certified and equally experienced in vaginal and robotic surgery. Residents on this rotation learn how to complete a full urodynamic work-up and to perform pelvic organ prolapse quantification exam. They participate in a variety of pelvic floor surgical procedures. This is a rotation where residents master and gain volume in performance of vaginal hysterectomy and mid urethral sling. Urogynecology ambulatory curriculum allows residents to identify and manage different pelvic floor disorders and participate in pelvic floor physical therapy clinic. In addition, this rotation offers intensive exposure to patients with chronic pelvic pain. Didactic lectures are also given by attending physicians specializing in the field.

Our residents encounter patients with gynecologic malignancies on the general gynecologic in-patient services and the gynecologic oncology service. This exposure occurs in the second, third and fourth years.

During these rotations, the residents participate in the care of all patients admitted onto the service. A large volume of surgery is done on this service and the residents have a very good experience participating in these cases. They also see patients in the office and follow these patients to surgery or other therapies. Throughout their training, the residents also attend numerous oncology and pathology conferences. At these conferences, the management of the oncology patients is discussed and the principles of radical surgery, chemotherapy, radiation therapy and brachytherapy are reviewed.

You will have week day call at both hospitals, which includes a night float person(s) who covers labor and delivery, postpartum, gynecology, and emergency.

Wednesday mornings from 7 a.m. to noon is protected time for educational didactic conferences. Conferences include grand rounds lectures, morbidity and mortality improvement conferences, obstetrics morbidity and mortality, primary care topics, urogynecology, reproductive endocrinology, gynecologic oncology, and maternal fetal medicine conferences. On the third Wednesday of every month (September to May) we hold the visiting professor program where national speakers are invited. Other conferences throughout the week include morning report, journal club, fetal anomaly board, and gynecologic tumor conference.

Each residents is required to a complete research project through established research curriculum with defined rotation and dedicated time during didactics. Research associate program director facilitates opportunities for residents to complete their research project. For research support, the scholarly activity support team can assist. The scholarly activity support team offers biostatistics consultation and poster preparation. Residents are required to present an abstract at an institutional Research Day during their PGY-3 year and produce and submit manuscript during their PGY-4 year.

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• Inclusion Resource Groups
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