Residency Rotation Descriptions

Residency in the Department of Obstetrics and Gynecology provides excellent training in all phases of obstetrics and gynecology through a system of progressive responsibility. The senior resident is responsible for the operation of his or her clinical service.

Three faculty members are always available as consultants and supervisors in-house at Parkland Memorial Hospital 24 hours a day, 365 days a year.

Resident rotations are within the following academic divisions:

We also have Departmental rotations in Prenatal Diagnosis and Clinical Genetics, the Women's Intermediate Care Center (ICC)Continuity Clinic, and Internal Medicine.

Gynecology

Gynecology is divided into four separate services that are supervised by a faculty member, a senior resident, a third-year resident, and a first- or second-year resident.

Responsibility is graded, with the senior resident having decision-making responsibility regarding patient care and surgical management. As a result, fourth-year residents primarily manage the gynecology service with the assistance from their third-year member.

Attempts are made to allow third-year residents to remain on the same gynecology service for two consecutive months to provide better continuity of care. There is close coordination between all residents and the supervising attending faculty.

In total during their training, residents spend 16 months on the Parkland Hospital Gynecology Service. Each service has an ambulatory gynecology clinic two days a week and two full operating days a week. In addition, each service sees patients in Dysplasia Clinic one half day each week. Here, residents learn how to identify, evaluate, and treat cervical, vaginal, and vulvar dysplasia and other premalignant diseases. Laser, Cryotherapy, CUSA (Cavitron Ultrasonic Surgical Aspirator), and loop electrocautery therapies are available.

Residents also rotate through subspecialty clinics like the Vulvology Clinic.

Adding to the basics, our Department has made revolutionary advances in its surgical education curriculum with the introduction of a video-laparoscopic training program at the state-of-the-art UT Southwestern Center for Minimally Invasive Surgery (SCMIS). SCMIS enables residents to improve video eye-hand coordination and acquire laparoscopic suturing, knot tying, and tissue handling skills in a virtual operating room setting.

Each service admits patients through the Obstetrics and Gynecology Intermediate Care Center (ICC) twice a week on a rotational basis.

During both the third year and fourth year there are 20 weeks of rotations for residents to get advanced gynecologic pelvic surgical experience at local private hospitals.

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Female Pelvic Medicine and Reconstructive Surgery

Second- and third-year residents spend one block on the Urogynecology and Reconstructive Pelvic Surgery Service for a total of two blocks' experience during the Residency Program.

The Service consists of a faculty member, a urogynecology fellow, a third-year resident, and a second-year resident. Residents have primary responsibility for the inpatient urogynecology service at Parkland Memorial Hospital, St. Paul University Hospital, and Zale Lipshy University Hospital. This includes pre-operative, intra-operative, and post-operative care.

Residents become proficient in evaluating patients with urinary incontinence, pelvic organ prolapse, and related disorders of the lower genital urinary tract. In addition, they will learn how to perform basic and complex urodynamic testing and become familiar with surgical and non-surgical methods for treating incontinence and prolapse.

The rotation involves one and a half days a week in the Parkland Urogynecology Clinic, where the resident performs patient evaluation, urodynamic testing, and has primary responsibility for patient care. Two days a week are spent in the operating room performing pelvic reconstructive surgery and anti-incontinence procedures.

Two half-days a week are spent in the anatomy lab to dissect unembalmed female cadavers and to become familiar with pelvic anatomy.

The second-year resident also spends a half-day each week working at the East Dallas Health Center. Here, the resident is responsible for basic evaluations in geriatric patients and initiating non-surgical and surgical therapy. The resident supervises a nurse practitioner in the East Dallas Health Center.

Both the second-year and the third-year resident spend one half-day a week in urogynecology didactic conferences. These conferences include journal club, textbook review, and case conferences. Residents will be responsible for some presentations during these conferences.

During their months on the Urogynecology Service residents benefit from an opportunity to work with and learn from physicians in the Female Pelvic Medicine and Reconstructive Surgery Fellowship Program.

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Reproductive Endocrinology and Infertility

The Reproductive Endocrinology Service consists of a faculty member, a Reproductive Endocrinology and Infertility (REI) fellow, and a third- and fourth-year resident. The service provides care at the UT Southwestern Outpatient Building, St. Paul University Hospital, Zale Lipshy University Hospital, and Children’s Medical Center Dallas

Clinical procedures include ovulation induction, intra-uterine insemination, IVF-ET, ultrasonography, tubal reanastomosis, uterine and vaginal reconstructive surgery, and diagnostic and operative laparoscopy and hysteroscopy.

In addition to private practice, the Division staffs the Reproductive Endocrinology Service at Parkland Memorial Hospital. Clinic is held one morning a week and averages 20-30 patients per session.

Diagnoses frequently encountered include PCOS, amenorrhea, hyperprolactinemia, uterine anomalies, endometriosis, infertility, premature ovarian failure, and recurrent pregnancy loss.

Residents see private REI patients with faculty and assist in surgical procedures. The residents are encouraged to attend weekly conferences held by the Division, as well as daily inpatient rounds.

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Gynecologic Oncology

Second- and third-year residents rotate on the Gynecologic Oncology Service and provide care for the patients at Parkland Memorial Hospital, St. Paul University Hospital, and Zale Lipshy University Hospital. The team is supervised by a gynecologic oncology faculty member and fellow.

The residents are responsible for the comprehensive inpatient and outpatient care of the gynecologic oncology patient, including benign aspects of cancer procedures, assisting with radical procedures, pre- and post-operative management, critical care, pain control, chemotherapy, radiation, terminal care, and management of complications.

Patients are cared for at Parkland Memorial Hospital, St. Paul University Hospital, Zale Lipshy University Hospital, Harold C. Simmons Comprehensive Cancer Center, and James W. Aston Ambulatory Care Center.

Teaching is a priority of the Division. Accordingly, attending faculty are present at all procedures, weekly Parkland Gynecologic Oncology Clinic, and daily rounds. Teaching conferences include a weekly tumor board, Parkland patient care, and monthly gynecologic oncology journal club and grand rounds. The Division is an active participant in clinical and basic research and welcomes resident collaboration.

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Obstetrics and Maternal-Fetal Medicine

The Obstetrics Service at Parkland Memorial Hospital delivered 13,500 babies in 2010. There were also 1,500 deliveries at St. Paul University Hospital. This provides excellent experience in both the common and rare complications of pregnancy.

For more than a decade, more than 97 percent of the women delivering at Parkland receive prenatal care in one of our nine community clinics staffed by nurse practitioners, certified nurse midwives, and faculty.

In addition, 10 half-day obstetrics complication clinics meet each week at Parkland. These clinics are designed for women with specific complications of pregnancy, including, for example, multiple gestation, anemia, prior preterm birth, diabetes, and infectious diseases.

The clinics are staffed by residents, nurse practitioners, certified nurse midwives, and Maternal-Fetal Medicine faculty and fellows.

The Parkland Obstetric Service consists of four teams, each composed of a faculty attending and first-through fourth-year residents. Each obstetrics team covers Labor and Delivery every fourth daytime period. Separate night float rotations are used for Labor and Delivery night call. This divides Labor and Delivery rotations into two 12-hour periods. The on-call schedules maximize continuity of both patient care and resident experience.

Third-year medical students are closely integrated into the Obstetrics Service rotation. In addition, many UT Southwestern fourth-year students and students from medical schools nationwide elect clinical rotations in obstetrics at Parkland.

Within Parkland are three Labor and Delivery units (L&D West, L&D East, and L&D 4 South South) that receive patients from a contiguous third-trimester obstetrics emergency room (L&D Triage Unit). All of these units function interdependently. The L&D Triage Unit is staffed by nurse practitioners also under the supervision of house officers and attending physicians.

Generally, multiparous women with uncomplicated pregnancies are triaged to L&D 4 South South. The 4SS Unit consists of six Labor, Delivery, and Recovery (LDR) Rooms. Nulliparous women with predominantly uncomplicated pregnancies are triaged to L&D East, which consists of 12 labor rooms (8 LDRs) and two operating rooms.

Both L&D 4SS and L&D East are staffed by certified nurse midwives under the direct supervision of Ob/Gyn residents and faculty. Most of the certified nurse midwives are graduates of the Parkland School of Midwifery, and approximately 50 percent of births at Parkland are attended by midwives directly supervised by physicians.

L&D West receives complicated pregnancies from the Triage Unit. L&D West also includes a separate operating suite for elective surgery (antepartum surgery, cesarean deliveries, puerperal sterilization, and missed abortions). L&D West consists of 18 labor beds, four delivery rooms, and five operating rooms, with a contiguous obstetrics recovery room and an obstetric critical care unit.

Medical complications of pregnancy are directly managed by the Obstetric Service with consultations from other medical disciplines as indicated.

A High-Risk Pregnancy Unit also provides antepartum hospital care to more than 1,000 women each year. The 29-bed unit on 5 South at Parkland continues to be one of the most popular rotations for residents.

Three postpartum wards are staffed by four physician obstetrics teams, and three postpartum wards for uncomplicated patients are staffed by nurse practitioners and certified nurse midwives, supervised by residents and faculty physicians. Approximately 50 percent of women delivered at Parkland are managed in the latter three nurse practitioner/certified nurse midwife units.

Residents receive formal individual training in sonography in a dedicated Ob/Gyn Ultrasound Unit. In 2010, our physicians performed 11,373 obstetrical ultrasound procedures.

Support services include a large blood bank and surgical pathology department. Obstetric anesthesia is provided by full-time faculty and residents from the Department of Anesthesiology and Pain Management at UT Southwestern. They provide services for labor epidurals, cesarean sections, vaginal deliveries, and puerperal sterilizations. A multidisciplinary obstetric anesthesia conference meets twice a month.

Obstetrics Service Grand Rounds are held each week on Wednesday morning. There are also weekly conferences on the High-Risk Unit.

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Prenatal Diagnosis and Clinical Genetics

Faculty specializing in Prenatal Diagnosis and Clinical Genetics provide comprehensive evaluation, diagnosis, and treatment of individuals with certain medical complications, genetic diseases, and congenital malformations

Services provided at Parkland Memorial Hospital include maternal serum screening for birth defects, cystic fibrosis screening, and invasive fetal testing, including chorionic villus sampling, amniocentesis, and fetal blood sampling. Three genetic counselors coordinate care and help teach the residents.

The ultrasound laboratory at Parkland has six new high-resolution machines, including one with 4-D capability.

A weekly Obstetrics-Genetics Clinic at Parkland is staffed by first- and fourth-year residents as part of the ultrasound rotation and provides experience in genetic evaluation, counseling, and prenatal diagnosis. The Service also works closely with the cytogenetics laboratory of the Department of Pathology.

Twice each month, multidisciplinary teaching conferences review complex fetal anomalies and genetic conditions, with fellows and faculty from the Divisions of Maternal-Fetal Medicine and Neonatal-Perinatal participating in discussion of fetal therapy and pregnancy management.

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Women’s Intermediate Care Center

The Parkland Obstetrics and Gynecology Women's Intermediate Care Center (ICC) functions like an ambulatory urgent care clinic, accepting walk-in patients with minor and major complaints. The area is staffed by first- and second-year residents.

Nurse practitioners and physician's assistants evaluate some routine patients. A senior resident and a faculty member provide supervision and teaching. This unique area provides care to more than 26,000 patients annually and is open 24 hours daily. Third- and fourth-year medical students find this to be one of their favorite Ob/Gyn areas because of the hands-on experience.

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Continuity Clinic

With the combined efforts of the Department of Obstetrics and Gynecology and Parkland Health & Hospital System, the Ob/Gyn Continuity Clinic opened at Lakewest Women's Health Center in 2005. This Clinic enables all residents to develop ongoing patient-physician relationships with a panel of ambulatory gynecology patients throughout the four years of residency.

The Lakewest Continuity Clinic is located within two miles of Parkland Memorial Hospital in a community multi-use center that houses a YMCA and a police substation. There are 12 examination rooms, a nurse practitioner staff, and specific Continuity Clinic support staff that includes designated language assistants.

Each resident is assigned to this Clinic one half-day per week, with the particular day varying with the rotation. Our computer-based resident schedule software system is integral to the Continuity Clinic, allowing residents to book patients to their particular schedules, thus insuring continuity for both patient and physician.

The Lakewest Continuity Clinic meets eight half-day sessions per week, each attended by four to six residents from all four years of training. The patients seen include referrals from postpartum services and the ICC (Gynecology Emergency Room), as well as the other resident continuity clinics. Nearly 8,500 patients were seen in 2009.

Lakewest Continuity Clinic allows the residents to participate in patient care similar to that in a private practice. This includes the opportunity to work directly with certified billing and coding specialists in the clinic to understand those aspects of the provision of women's health care.

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Internal Medicine

Residents spend two rotations in the first year on Internal Medicine. One rotation is in an intensive care unit, and one rotation is on the General Internal Medicine Service. In the senior year, residents attend weekly half-day sessions in the Osteoporosis Clinic on the Reproductive Endocrinology Rotation and Geriatrics Clinics on the Urogynecology Rotation.

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