Ob/Gyn Residency Clinical Training
The Obstetrics and Gynecology residency program divides the academic year into 13 blocks, each of four weeks duration. The table below shows the number of blocks each PGY level experiences of each clinical rotation.
Clinical rotations occur primarily at Parkland Memorial Hospital, which is the county hospital in Dallas. Residents also rotate at Williams P. Clements University Hospital and Children’s Medical Center Dallas.
|Ob/Gyn Emergency Services||2-3||2-3|
|Sonography & Genetics||0.5||1|
Each intern spends one block in the Parkland Medical ICU, where they establish a foundation in critical care medicine that will be built upon as PGY-3 residents managing the Extended Care Unit (ECU) on the Obstetrics rotation. During the MICU rotation, residents participate in Internal Medicine didactics. The MICU schedule utilizes a night float system rather than 24-hour call.
Women presenting to the Parkland ER with gynecologic complaints or obstetrics issues prior to 20 weeks gestation are triaged to the OGES. Less urgent patients are seen by nurse practitioners whereas patients with complex presentations or medical or surgical emergencies are evaluated by our PGY-1 and PGY-2 residents under direct faculty supervision. This unique area provides care to more than 20,000 patients annually and provides our residents exposure to issues such as ovarian torsion, ruptured ectopic pregnancy, pelvic infections, and medical complications of early pregnancy. The residents’ schedule on this rotation utilizes shift-work rather than 24-hour call.
This is an outpatient rotation where interns spend 2 weeks in the Parkland Family Planning Clinic learning foundational aspects of reproductive health care, such as contraception counseling, LARC placement and removal, routine health maintenance, and preventative care.
Our program previously also provided opt-out termination training to the PGY-4 residents; however, this as been suspended due to recent state legislative changes. We are currently working on a revised Complex Family Planning resident curriculum.
PGY-1 and PGY-4 residents rotate through the Parkland Sonography suite to obtain technical experience in performing obstetric and gynecologic scans. The residents also work closely with radiology faculty and MFM faculty to learn to read acquired images. Every two weeks, residents attend a multidisciplinary teaching conference to review complex fetal anomalies and genetic conditions. They also attend a weekly Obstetric Genetics Clinic to gain experience in genetic evaluation, counseling, and prenatal diagnosis.
There are four obstetric services at Parkland, each comprised of an MFM faculty, a generalist faculty, and one resident of each PGY level. Each day, residents manage antepartum and postpartum patients on the ward. On a four-day rotating basis they will perform elective Obstetric surgical cases such as repeat cesarean deliveries or cerclage placement, manage the low-risk and high-risk Labor and Delivery unit including the Extended Care Unit, and attend the MFM Clinic. They also have a dedicated education morning every four days where they participate in simulation or small group didactic learning. There is no overnight call on this rotation.
There are two resident teams who cover the Parkland obstetric service at night. Each team is comprised of an MFM faculty, a generalist faculty, and one resident from each PGY level. Interns are responsible for inpatient cross cover, vaginal deliveries, and general management of the patients on Labor and Delivery. PGY-2 residents are responsible for L&D triage, cesarean sections, and management of the low-risk L&D unit. PGY-3 residents are responsible for performing cesarean sections and managing patients in the Extended Care Unit (ECU), which acts as a step-down ICU for antepartum and postpartum patients. PGY-4 residents are responsible for managing and overseeing all aspects of L&D and the ECU. These L&D responsibilities are the same as those assigned on the Obstetrics rotation. Residents on the OB Nights rotation typically work four shifts followed by two nights off.
PGY-2 and PGY-4 residents rotate through the Parkland High-Risk maternity ward, also known as 7A. On this rotation, under MFM fellow and faculty supervision, they manage obstetric patients requiring hospitalization for conditions such as diabetes, hypertension, polysubstance abuse, preterm/prelabor rupture of membranes, arrested preterm labor, or symptomatic morbidly adherent placenta. They also attend the MFM Clinic each afternoon. They attend a weekly multidisciplinary conference with neonatology to coordinate delivery planning and discuss outcomes of previously delivered infants and mothers. They are also invited to attend a bi-weekly multidisciplinary teaching conference to review complex fetal anomalies and genetic conditions. There is no overnight in-house call on this rotation; however, PGY-4 residents will take home call for patient-care questions.
PGY-3 residents rotate through the MFM service at the Williams P. Clements University Hospital. On this rotation, they manage obstetric patients requiring hospitalization for similar conditions as described above for 7A and assist in delivery of these patients. They attend clinic with the MFM physicians to gain experience in consultation and counseling of high-risk obstetric patients. They also gain additional experience performing and reading ultrasound. Residents take 24-hour Saturday call on this rotation.
There are three Parkland gynecology services that are comprised of a faculty, PGY-4, PGY-3 and lower-level resident. There is an additional team comprised of a MIGS faculty and fellow with an upper-level resident and a lower-level resident. Each of these four teams have two days in clinic and two days in the OR each week. For the lower-level, one of the OR days occurs at the Parkland Ambulatory Surgery Center where they perform elective minor surgeries one-on-one with a faculty. Main OR cases include use of conventional laparoscopy, robotics, conventional vaginal hysterectomy, vNOTES, and other endoscopic approaches. PGY-3 residents take 24-hour Saturday call on this rotation.
One PGY-2 resident is assigned to this rotation each block. This resident is responsible for gynecologic consults that come from the Parkland OGES, ER, and inpatient floors. They are also the first-call provider for all inpatients on the benign Gynecology service. The Gyn Nights resident performs any overnight urgent or emergent surgeries with the Gynecology faculty on-call, which can include cases such as ovarian torsion, ruptured ectopic pregnancy, or vulvar or pelvic abscess. These residents work night shift Monday through Friday.
PGY-2 and PGY-3 residents rotate on the FPMRS service at both Parkland and Clements Hospital where they participate in the clinical evaluation, medical management, and surgical management of female urogynecologic conditions. This rotation also includes a bi-weekly cadaver lab where residents perform advanced anatomic dissection and simulation of hysterectomy and urogynecologic procedures. These residents also participate in FPMRS didactics. These residents do not have an in-house call obligation but do take home-call for service needs.
Residents gain experience with reproductive endocrine disorders on the REI/PAG rotation. On REI, residents observe and perform adult endocrinology and infertility care in both an academic center and private practice setting. They are involved in patient counseling, transvaginal ultrasounds for patients undergoing fertility treatment, intrauterine insemination, oocyte retrieval, and embryo transfer. On the PAG portion of the rotation, residents attend clinic and surgeries with our faculty at Children’s Medical Center. They participate in management of endocrine disorders, muellerian anomalies, and routine gynecologic care of the adolescent. They are also able to attend clinic sessions at GENECIS with our PAG faculty, which is an adolescent transgender clinic. Residents do not take in house call for this rotation however do take home-call for service needs.
Six residents cover the Gyn Onc services at Parkland and Clements hospitals each block. They attend clinic and surgery at both Parkland and Clements and manage the inpatient service at each hospital. Surgeries include conventional laparoscopy and robotics. Residents also participate in weekly tumor board and a monthly journal club and Morbidity and Mortality conference. PGY-3 residents take 24-hour call on Saturday. PGY-2 residents spend one to two weeks covering the service as night float.
On this rotation, PGY-4 residents are able to further hone their skills by participating in Gynecologic surgery at Clements University Hospital and university-affiliated Texas Health Resources (THR) hospitals in Dallas and Frisco. Cases include use of conventional laparoscopy, robotics, conventional vaginal hysterectomy, vNOTES, and other endoscopic approaches. At Clements, residents also cover ER consultations and attend clinics with MIGS faculty, vulvar dermatology, and pelvic floor physical therapy. At THR-Frisco, residents attend clinic with private-practice faculty and gain experience in ambulatory gynecology including hormone replacement therapy, sexual dysfunction, and vulvar disorders.