Obstetrics and Gynecology Emergency Services (OGES)

The OGES is a unique area within the Parkland ED dedicated to women presenting with gynecologic complaints or obstetrics issues before 20 weeks' gestation.

With more than 20,000 patients treated annually, the OGES provides residents exposure to a wide range of conditions, including ovarian torsion, ruptured ectopic pregnancy, pelvic infections, and medical complications of early pregnancy.

This rotation follows a shift-work schedule rather than 24-hour call.

Parkland Family Planning

During this rotation, residents spend time at the Parkland Family Planning clinics and the Parkland Early Pregnancy Loss Clinic. They learn fundamental aspects of reproductive health care, including contraception counseling, placement and removal of long-acting reversible contraceptives (LARC), routine health maintenance, and preventive care. They also learn miscarriage management using medication, office manual aspiration, and procedural management in the operating room.

During this rotation, fourth-year residents have the ability to travel out of state to receive opt-out induced abortion training.

Sonography & Genetics 

During this block, residents gain technical expertise by performing obstetric and gynecologic scans. They work closely with faculty from the Department of Radiology and our Division of Maternal-Fetal Medicine to learn how to read sonography images.

Every two weeks, multidisciplinary teaching conferences are held to review complex fetal anomalies and genetic conditions. Additionally, residents attend a weekly Obstetric Genetics Clinic to gain hands-on experience in genetic evaluation, counseling, and prenatal diagnosis.

Parkland Obstetrics

Our Obstetrics Service at Parkland is covered by four resident teams, each consisting of a Maternal-Fetal Medicine faculty member, a General Obstetrics and Gynecology faculty member, and a resident from each PGY level.

Residents manage antepartum and postpartum patients on the Labor & Delivery ward throughout this block. On a four-day rotating schedule, resident responsibilities include performing elective obstetric surgical cases, managing both low-risk and high-risk Labor & Delivery units, and attending the Parkland Maternal-Fetal Medicine Clinic. Interns on the Obstetrics rotation also spend time in Sonography during the four-day rotating schedule.

This rotation includes dedicated education mornings for simulation and small- group didactic learning. There is no overnight call required on this rotation.

Parkland Obstetrics Night Service

During this rotation, residents assume various responsibilities based on their PGY level.

• PGY-1 residents handle inpatient cross cover, vaginal deliveries, and general patient management in Parkland's Labor & Delivery unit.
• PGY-2 residents are responsible for L&D triage, cesarean sections, and managing the low-risk L&D unit.
• PGY-3 residents perform cesarean deliveries and manage patients in the Extended Care Unit (ECU), which acts as a step-down ICU for antepartum and postpartum patients.
• PGY-4 residents oversee all aspects of L&D and the ECU.

The Obstetrics Nights rotation follows a schedule of four shifts followed by two nights off.

Maternal-Fetal Medicine (MFM)

This block is for PGY-2, PGY-3, and PGY-4 residents. Under the guidance of Maternal-Fetal Medicine Division faculty and fellows, residents manage obstetrics patients requiring hospitalization for various conditions such as diabetes, hypertension, polysubstance abuse, preterm/pre-labor rupture of membranes, arrested preterm labor, and symptomatic morbidly adherent placenta.

PGY-2 and PGY-4 residents rotate through the Parkland high-risk maternity ward, also known as 7A.

• These residents attend the Parkland MFM Clinic each afternoon and have a weekly multidisciplinary conference with Neonatology to coordinate delivery planning and discuss outcomes of previous cases.
• There is no overnight in-house call on this rotation, but PGY-4 residents take home call for patient-care questions.

PGY-3 residents rotate through the MFM service at Clements University Hospital.

• These residents attend clinic with our MFM providers to gain experience in consultation and counseling of high-risk obstetric patients.
• The residents also have exposure to sonography and gain additional experience performing and reading ultrasounds.
• PGY-3 residents take 24-hour Saturday call on this rotation.

Parkland Gynecology

The Parkland Gynecology service consists of three resident teams, each comprising a faculty member, a PGY-4 resident, a PGY-3 resident, and either a PGY-2 or PGY-1 resident. Additionally, there is a fourth team consisting of an upper-level and a lower-level resident led by a Minimally Invasive Gynecologic Surgery faculty and fellow.

Each of these four teams spends two days in clinic and two days in the operating room (OR) each week. The main OR cases involve laparotomy, conventional laparoscopy, robotics, conventional vaginal hysterectomy, vaginal natural orifice endoscopic surgery (vNOTES), and other endoscopic approaches.

Lower PGY-level residents have the opportunity to perform elective minor surgeries with a faculty member at the Parkland Ambulatory Surgery Center one day per week.

PGY-3 residents are responsible for 24-hour Saturday call on this rotation.

Parkland Gynecologic Night Service

One PGY-2 resident is assigned to this rotation each block.

This resident handles gynecologic consults from the Parkland OGES, ER, and inpatient floors. Additionally, they serve as the first-call provider for all inpatients on the Gynecology service.

The Gynecology Night resident also performs overnight urgent or emergent surgeries alongside the on-call Gynecology faculty. These cases might include conditions such as ovarian torsion, ruptured ectopic pregnancy, or vulvar or pelvic abscess.

During this rotation, the assigned resident works night shifts from Monday through Friday.

Female Pelvic Medicine and Reconstructive Surgery (FPMRS)

PGY-2 and PGY-3 residents rotate on the FPMRS service at both Parkland and Clements University Hospital.

During this rotation, residents actively participate in the clinical evaluation, medical management, and surgical treatment of female urogynecologic conditions. To enhance their skills, residents also engage in a bi-weekly cadaver lab where they perform advanced anatomic dissection and simulate procedures such as hysterectomy and urogynecologic surgeries.

FPMRS didactics are also included in this rotation.

Although there is no in-house call obligation for these residents, they are available for home-call service needs.

Reproductive Endocrinology and Infertility (REI) & Pediatric Adolescent Gynecology (PAG)

During the REI/PAG rotation, residents gain expertise in reproductive endocrine disorders.

REI
Residents observe and participate in adult endocrinology and infertility care, including patient counseling, performing transvaginal ultrasounds for fertility treatment patients, and assisting with procedures such as intrauterine insemination, oocyte retrieval, and embryo transfer.

PAG
Residents accompany our faculty at Children's Medical Center Dallas for clinic sessions and surgeries and participate in the management of endocrine disorders, Mullerian anomalies, and routine gynecologic care for adolescents. Residents do not have in-house call obligations for this rotation but are available for home-call service needs.

Gynecologic Oncology (Gyn Onc)

Our Gynecologic Oncology services at Parkland and Clements are covered by five residents each block who attend clinic and actively manage the inpatient service.

Residents also attend surgery at both hospitals, which includes conventional laparoscopy and robotics. Residents participate in weekly Tumor Board meetings, a monthly journal club, and Morbidity and Mortality conferences.

PGY-3 residents are responsible for 24-hour call on Saturdays, while PGY-2 residents cover the service as night float for one to two weeks.

Private Gynecology

This rotation offers PGY-4 residents the opportunity to refine their skills in gynecologic surgery. They actively participate in surgical procedures at Clements University Hospital and our affiliated Texas Health Presbyterian Hospital Dallas and Texas Health Frisco partners. The cases involve various techniques such as conventional laparoscopy, robotics, conventional vaginal hysterectomy, vNOTES, and other endoscopic approaches.

At Clements, residents also cover ED consultations and attend clinics with our specialists in minimally invasive gynecologic surgery, vulvar dermatology, and pelvic floor physical therapy.

At Texas Health Frisco, residents attend clinic sessions with private-practice faculty, gaining experience in ambulatory gynecology, including hormone replacement therapy, sexual dysfunction, and vulvar disorders.