The VCU Health System is an urban university teaching hospital with approximately 2,300 annual deliveries, managed by the Department of Obstetrics and Gynecology. Approximately 40 percent of these deliveries prove to be “high-risk” throughout the pregnancy, labor and delivery, and postpartum period.
Twenty-four hour anesthesia services are provided by the Department of Anesthesiology. These specialists teach the principles of obstetrics anesthesia and anesthetic techniques.
Over 10,000 patients were seen in the gynecology clinics and approximately 1,500 major operative procedures and approximately 1,000 minor procedures were performed. GYN continuity clinics allow for complete preoperative evaluation and trial of conservative medical therapy prior to scheduling for surgery. All in-patient surgical cases are reviewed at weekly preoperative teaching rounds followed by a review of all surgical pathology. Statistics and complications are presented on a weekly basis. Problem cases are presented for discussion.
Instruction and experience in urogynecology, including Urodynamics, is part of the PGY-2 and PGY-3 experiences on the outpatient service.
The residents gain experience and knowledge in gynecologic malignancies through formal teaching sessions, a structured system of teaching rounds and conferences, participation in the outpatient chemotherapy and the critical care management of these patients, as well as surgical and medical management of radiation therapy patients.
The residents also gain additional experience and instruction in gynecologic oncology at Johnston Willis Hospital in Richmond, VA as PGY-4s.
Infertility and Endocrinopathies
There is a PGY-2 resident assigned to the Endocrine and Infertility Service. These residents see both staff and private outpatients, participate in outpatient laparoscopic and hysteroscopic surgery, perform procedures such as gynecologic ultrasonography, hysterosalpingograms, endometrial biopsies and post-coital tests and scrub on microscopic and macroscopic reconstructive surgery. The residents participate in pre- and post-operative care for the major surgical cases.
General Obstetrics and Gynecology
The accumulation of experience and knowledge in general obstetrics and gynecology is an ongoing process with contributions from all sections of the department. Teaching in ambulatory care is accomplished through didactic material as part of the resident core lecture series, and through on-site attending coverage of the ambulatory care areas of the department. Teaching in these areas covers management of common problems in ambulatory gynecology, including infectious diseases, colposcopy, basic endocrinology, office diagnostic hysteroscopy and the prenatal management of routine obstetrical patients. In the inpatient setting, instruction is provided through teaching conferences in labor and delivery and antepartum management, gynecology preoperative teaching conferences, teaching rounds on the antepartum and gynecology services and direct supervision of resident activity in labor and delivery and operating rooms. In addition, the PGY-3 residents provide two months of intensive surgical training in a local private hospital.
The pathology experience is reinforced as the residents rotate through Gynecology and Gynecologic Oncology, where all of the case material is reviewed at their conferences and the slides presented. Along with this, experience in performing fine needle aspirations of breast and reviewing cytology is available.
The Department of Obstetrics and Gynecology operates and supervises five “state of the art” ultrasound systems utilizing both linear and phased array sector scanning. Consequently, exposure to obstetrical ultrasound is great throughout the residency due to the availability of these ultrasound systems.
PGY-1 and PGY-2 are specifically assigned to the OB/GYN diagnostic testing center. Under daily attending physician supervision and with the technical expertise of two full time ultrasound technologists, the resident gains proficiency in the performance and interpretation of routine Level I obstetrical ultrasound. Each resident is able to obtain basic obstetrical ultrasound information and fetal measurements. As a referral center, the resident is exposed and gains a certain degree of proficiency in Level II fetal imaging to rule out or confirm various fetal anomalies. The resident is also instructed in the performance and interpretation of the various modalities of fetal surveillance including non-stress tests, biophysical profile and Doppler wave form evaluation.
Lecture series have been devoted to the physiology of the menstrual cycle, the principles of fertility regulation, oral contraception and sterilization procedures. These topics are repeated on a two-year cycle. Grand Rounds presentations include talks by departmental faculty and visiting professors related to complications of sterilization and new developments in contraception. Formal weekly Gynecology Service conferences include discussion on contraceptive choices, contraceptive complications, vasectomy and abortion. Clinical experience related to family planning is ongoing throughout the four years of residency.
Abortion techniques are learned during Ambulatory Surgery rotations. They are supervised both by full-time faculty and part-time faculty who use this facility extensively for this purpose. Participation in elective termination of pregnancy is not mandatory.
- Cognitive: Resident levels PGY-1 through PGY-4 are all enrolled in the annual CREOG In-Training Examination.
- Technical: The residents are supervised in their technical procedures on all of their operative rotations and formally evaluated. If their technical skills are observed by the faculty to be unsatisfactory, the resident receives counseling and special instruction to bring their skills to a satisfactory level.
- Behavior: At the conclusion of each rotation, all residents are formally evaluated regarding core competencies, attitude, patient relationships, teaching ability, sense of responsibility, etc. The faculty members responsible for the rotation evaluate each resident.
A close relationship develops between the residents and the faculty during the four years of education. There is a very strong alumni organization, The Ware-Dunn Society that keeps constant contact between the groups. The Alumni Society provides a loan fund for residents who have financial difficulty and funds three visiting professors each year. The Department holds a three-day postgraduate course for the alumni each year which brings back a large number of former residents. There are several social functions scheduled during those days to allow renewal of friendships and informal interchange.
The research activities at the VCU School of Medicine are strong. The institution as a whole ranks in the upper one-third of all schools of medicine for NIH supported research. The Department of Obstetrics and Gynecology has multiple research programs, both clinical and laboratory. Our department has been ranked by the American Association of Medical Colleges as 13th in Obstetrics and Gynecology in NIH funded research.
All residents are encouraged to participate in any of our established research programs and pursue independent research if the resident skills and needs are considered appropriate. At the conclusion of the research, typically during the PGY-4 year, there is an opportunity to present research findings at the OB/GYN Annual Resident Research Day as well as the institutional Resident Research Day.
Thursday mornings are dedicated to didactic education for the residents and students. Each week Grand Rounds are presented, followed by a faculty member giving a core lecture covering topics from CREOG Education Objectives weekly. The third lecture of the day is the resident driven conference keeping with the CREOG objective of the day. In addition, there is a Practice Based Learning Conference followed by one or two core conference and /or an Educational Conferences.