The first year Obstetrics rotation is focused on training in basic obstetrics: antepartum/postpartum care, cesarean sections, spontaneous vaginal deliveries. The intern also attends a weekly obstetrics clinic that provides training in routine prenatal care and pregnancy counseling.
The intern on the Gynecology team is an active participant in the in-patient care of patients with benign gynecologic and gynecologic oncology issues. This experience helps interns develop an understanding of the context necessary for learning the basic procedure skills. Additionally, the intern sees all Emergency Department consultations. The intern learns surgical skills and develops competence in performing D & Cs, abdominal incisions and closures, laparoscopic tubal ligations, adnexectomies and robotic surgical positioning/port placement. Second assisting on oncology cases provides the opportunity to learn detailed pelvic anatomy
Medical Intensive Care Unit
The intern spends one month in the medical intensive care unit learning the principles of critical care medicine by following individual patients under the supervision of a senior medical resident. . OBGYN interns participate fully in the management of critically ill patients and gain invaluable experience in cardio-pulmonary monitoring and airway management
During the second half of the intern year, the skills of obstetrical and gynecologic care acquired during the first part of the year are used in the management of patients as the Junior Night Float Resident. This rotation involves working alongside the Senior Night Float Resident and the covering attendings five nights/week. Much of this rotation involves the management of acute obstetrical patients; however, the resident is also exposed to the overnight care of gynecologic patients in the Emergency Room and on the ward. This rotation allows for further development of multitasking, triage and priority setting skills.
The rotation offers a breadth of outpatient experience that includes the care of routine Gyn patients, patients with endocrinology and infertility issues, and the skills acquisition for office based procedures (hysteroscopy, ultrasound, sonohysterograms) There are also two half days per week devoted to Pediatric Adolescent Gynecology.
Labor & Delivery
During this rotation, the resident manages the inpatient antepartum service and is responsible for the admission and management of all high-risk patients to Labor and Delivery. During this rotation, the resident is exposed to ultrasonography, amniocentesis, operative vaginal delivery, genetic counseling and antepartum testing and has the opportunity to refine C/S skills. Extensive experience with management of patients with complex medical and obstetrical problems is acquired. The resident attends the weekly multidisciplinary perinatal conferences as well as their own continuity clinic.
Maternal Fetal Medicine
The resident sees patients in the High Risk Maternal Fetal Medicine (MFM) clinics. The resident also gains further experience in performing OB ultrasounds in the Fetal Diagnostic Center. The resident also covers Labor and Delivery one day a week. Additionally the resident has the option to spend one day/week at Planned Parenthood learning how to perform pregnancy terminations. If the resident opts out of this experience she/he spends additional time in the MFM Clinic
The resident develops further skills in admitting, diagnosing and managing oncology patients. This rotation allows for the opportunity to develop competence in performing cervical conization, adnexectomy, endoscopic surgery, and ovarian cystectomy. She/he begins to develop skills in all types of hysterectomy techniques, robotic surgery, cystoscopy, colposcopy, proctoscopy, and radium application. The resident attends a breast care clinic weekly, working with a breast surgeon. The resident also works with our gynecologic oncologists in their clinics.
Reproductive Endocrinology and Infertility
The resident gains increasing experience in the management and evaluation of more complex endocrine patients as well as refines her/his skills in transvaginal ultrasound, and endoscopic and laser surgery. The resident participates in REI clinics and observes assisted reproduction procedures. The resident also participates in weekly REI didactics.
During the first half of the second year, the resident becomes the Junior Night Float. In this capacity, the resident builds on the experience gained as a First Year Night Float resident the year prior. In the second year, the resident is given progressively increasing levels of responsibility and independence in the care of patients, necessary to progress to the level of senior resident.
Two Months Elective
Residents are encouraged and supported in their goals to further pursue particular areas of interest and are given the flexibility to construct a two month elective rotation. Residents are to spend four weeks of their elective time locally, creating a valuable opportunity to focus on research or additional topics of interest to the resident (recent examples include obstetric anesthesia, perinatal genetics, etc.). The resident also has the option to arrange for an "away" rotation of 4 weeks duration. This time is intended to get experiences that are not available at our program, such as rotations which provide unique infectious disease or surgical experiences. Examples of these are the many international rotations our residents have set up in countries with high prevalence of HIV and/or tropical infections and oncology fellowships at Sloane Kettering. Some of the countries our residents have gone to include: Tanzania, Cameron, Uganda, and Philippines.
During this rotation, the resident refines her/his skills in the management of difficult medical and surgical gynecologic cases (all types of hysterectomies, robotic surgery, endoscopic surgery, and the management of post-operative complications. The resident has supplemental exposure seeing patients in the breast clinic, the oncology clinics as well as in the weekly continuity clinic.
The resident acts as the senior resident in the hospital. The resident is in charge of the Night Float team, which consists of the Night Float resident, a PGY-1 or 2, and a Family Medicine Resident. The resident oversees and directs the management of all patients, learning how to triage patients and oversee the junior residents. During this rotation, the resident hones her/his skills in independent decision making with increasing levels of responsibility. The resident works with CNMs, private practice and faculty attendings and is supported by 24 hour in-house attending coverage.
Maternal Fetal Medicine
This is similar to the High Risk Outpatient rotation during the second year. The resident attends three high-risk clinics including one clinic devoted to the care of diabetic patients. The resident also gains further experience in performing OB ultrasounds in the Fetal Diagnostic Center. The resident covers labor and Delivery one day a week. Additionally the resident has the option to spend a day at Planned Parenthood learning how to perform pregnancy terminations. If the resident opts out of this experience s/he spends additional time in the MFM clinic.
The resident will spend two days per week at Planned Parenthood; one full day will be spent performing surgical terminations and one day will be dedicated to learning contraceptive counseling. An additional half day will be spent at UVMC in our Family Planning Clinic (LARC/IUD placement). Finally, they spend one day a week working with both a pediatric gynecologist and a pediatrician specializing in adolescent reproductive health learning specific skills in the care of pediatric and adolescent patient populations. One half day/week is blocked for working with our geneticist learning the basics of prenatal genetic counseling.
This rotation entails working with a urogynecologist both in the office and operating room. The rotation focuses on evaluation of incontinence and pelvic floor disorders, urodynamic testing, and indications for urogynecologic procedures. The resident assists and learns to perform urogynecologic procedures as the first assist in the operating room.
Chief of Obstetrics
The Chief Resident manages the total obstetrical service with final authority and decision-making capability under the supervision of our attending faculty. S/he supervises and teaches the junior residents and medical students. The resident continues to have a continuity clinic but the patients are mostly complicated or term resident obstetric patients. The Chief Resident oversees the management of all the resident service obstetrical patients. The Chief Resident has a weekly ultrasound clinic at our Fetal Diagnostic Unit where s/he performs routine ultrasounds under the supervision of the US attending. The Chief Resident is responsible for a monthly fetal heart tracing conference and quarterly OB quality assurance presentations.
Chief of Gynecology
The resident is responsible for the preoperative evaluation of all benign gynecologic cases, assignment of surgical duties, and postoperative management. The residents have a dedicated monthly OR day for their clinic patients which is supervised by a GYN attending. The chief resident oversees the junior residents on service and acts as the attending for all resident service GYN cases. The resident gains skills and competency in hysterectomies by all routes, including robotic-assisted. The resident operates in all difficult abdominal and endoscopic cases.
Chief of Oncology
The resident assists in all oncology surgery cases and acts as primary surgeon when appropriate under the supervision of our gynecologic oncologists. S/he is responsible for the management of all gynecologic oncology patients, under the guidance of the attending staff. Extensive experience in preoperative preparation and management of post-operative complications is acquired. The resident sees patients in oncology clinic as well as her/his own continuity clinic. The chief resident is responsible for preparing cases and presenting to the multidisciplinary tumor board conference twice monthly.
Continuity of Care Clinics
During all four years of their residency, interns and residents in the OBGYN department at The University of Vermont Medical Center attend their own weekly continuity clinics during which they establish longitudinal care of their own patients, supervised by The University of Vermont Medical Center faculty. The only time residents are not scheduled to see their own patients is when they are on their MICU or Night Float rotations.