Our Obstetrics rotation has a team of four residents who manage the low risk and high risk patients admitted in the hospital. One of the residents is assigned to nights in a monthly block. During this rotation, the residents also attend the High risk clinic with the MFM attendings. High risk rounds are done daily with MFM attending. We also have a hospitalist service where the generalists rotate weekly to cover the staff and private patients. This allows the faculty to provide close supervision to the residents. Our obstetric volume comes from the faculty clinics, resident antepartum clinic and from the Health departments around the city where our faculty and residents see patients weekly.The residents also get an opportunity to work in community based hospital at Topeka were they deliver patients with private doctors. The wide range of patients available for our program allows us to provide a very complete and practical experience to all our residents.
Residents rotate through REI in there first and second year. During their rotation, they have the opportunity to become proficient in transvaginal ultrasound and general infertility issues. Our Center for Advanced Reproductive Medicine provides a full experience in the breadth of reproductive medicine. The residents also operate with our REI attendings in minimally invasive surgeries involving fibroids, endometriosis, uterine anomalies and various other tubal surgeries. They are also expected to be in outpatient clinics with the REI faculty
Our Gynecology rotation has a team of three residents including a resident at community hospital in Overland Park, KS. The residents are expected to scrub on all the surgeries at the university hospital. All the residents except the PGY1s have a continuity clinic weekly. Every effort is made so that the patients seen in the clinics are gynecological patients, so as to maximize the resident cases done in the OR. Through out he four years residents become well versed in general gyn surgery, laproscopy and urogynecological cases. They also have the opportunity to operate in robotic surgery and other minimally invasive surgeries.
Oncology rotation is one of our busiest rotations. There are two residents (PGY4 & PGY2) in this rotation. The residents work closely with our oncologists and hone their surgical skills. In addition to an extensive surgical experience, the residents also manage inpatient oncology service and see ambulatory patients in gyn-oncology clinic. Kansas University is also home of the regional Cancer center, so residents get a wide variety of cases that come from surrounding regions. One of our oncologists also covers the colposcopy clinic with the residents on Friday mornings.
Our department has had an affiliated training relationship with Stormont Vail/Saint Francis Medical Centers for more than three decades. The “Topeka rotation” initially was in the first year of residency training and emphasized routine obstetrics. For the past decade or more the rotation was moved into the third year of residency training in order to take advantage of the extensive surgical opportunities afforded to the residents at a more advanced level of training. Currently each resident spends two two-month blocks in Topeka and the bulk of that time is spent in the operating room performing gynecologic surgery. These opportunities include not only common procedures such as abdominal and vaginal hysterectomies, but, also minimally invasive surgery as well as uro-gynecology and pelvic reconstruction. Additionally, a resident does participate in night call, six nights a month, which does give them the opportunity to enhance their obstetrical experience both with vaginal deliveries as well as Caesarean sections. Housing is provided for residents, should they choose, although many residents elect to commute to Topeka as it is only on average a one hour drive each direction.
With the advent of the 80 hour work week requirements for residency training, our department re-instituted a night float system for coverage of Labor and Delivery. A decade ago we had a night float system in place, but, elected to abandon that as the resident who was on night float felt that they were segregated from the daytime activities within the department. Since re-instituting our night float system, we have taken steps to avoid that perception on the resident part. Not only does the resident stay in the morning through the teaching rounds on the high risk service, but, the schedule has been adjusted so that the resident can also participate in the full scheduled didactic activities on Friday afternoons. For the first three to four months of each academic year the night float resident is a second year resident. That allows each first year resident to spend at least one month on the obstetrical service before being placed in the position of the “night float resident.” The night float resident does indeed have significant management responsibilities both for the labor and delivery deck as well as patients that need to be seen in consultation through our Emergency Room. The night float resident is backed up, however, by a senior level resident. The night float shifts begin on Sunday evening at 6:30 in the p.m. and lasts until approximately 8:30 a.m. the following morning. That remains true on Monday through Thursday each week. The resident is dismissed home Friday afternoon and does not return, again, until Sunday evening when they are on the night float rotation.
During the first year of residency training each resident spends two months on our breast and ultrasound rotation. During that month the resident spends the bulk of their time in the fetal diagnostic unit performing and observing both routine obstetrical ultrasounds as well as complex targeted ultrasounds. One day each week is spent working with the breast surgeons at KU evaluating patients for either abnormal mammograms and/or breast examinations. One day a week is also spent in the Osteoporosis Clinic. At the completion of that training the resident is able to function independently on our labor and delivery deck with ultrasound screening for all of our obstetrical patients.
During the first year of residency training each resident spends one month assigned to the Emergency Department at the KU Medical Center. During that month they are relieved of obstetrical call and function with the other house staff in the Emergency Department seeing “all comers.” However, given the fact that they are residents in obstetrics and gynecology, the Emergency Room typically funnels any gynecologic issues to that resident when they are on duty.
Additionally, our house staff covers the Emergency Department for any gyn consults seen both day and night. The gynecology service provides coverage during the daytime hours Monday through Friday, and otherwise, the ON CALL team is responsible for responding to consultations in the ER on evenings and week ends.
As part of our resident curriculum, each resident is expected to perform a research project during the course of their residency training. The guidelines for these projects are somewhat broad and historically residents have performed a wide variety of projects. Examples extend from bench research in collaboration with PhD’s in our department or in the Department of Physiology to patient questionnaires regarding clinical experience and in LDRP. The one stipulation that we place upon these research project is that upon completion the project should, at least, be worthy of submission for publication. Whether or not it is actually published is up to the resident and the mentor that supports the resident in that endeavor. By the completion of the second year of training the resident is encouraged to have selected a topic and a mentor to help facilitate their completion of the project.
Each spring we have a Resident Research Day at which the third and fourth year residents present. The third year residents are expected to have their project outlined submitted to the IRB for approval and the fourth year resident is expected to present the completed project. Awards are presented to the best third and fourth year project each year as determined by an external referee who is invited by the department to speak at the Resident Research Day and to judge the residents presentations.
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