The North Oakland Medical Centers Obstetrics/Gynecology Residency Program was established in 1947. It is an independent, eight-resident program affiliated with the Wayne State University School of Medicine.

Purpose and Philosophy

The mission of the Obstetrics/Gynecology Residency program is to produce professionals who are surgically skilled, intellectually competent and capably trained in the specialties of obstetrics and gynecology. Resident obstetricians are trained to achieve optimal health for the prenatal and postpartum woman and her child. In addition, guidance is given on counseling, family planning, and healthy attitudes toward sex, family life and the family's role in society. The resident must also have a broad understanding of the physiology and pathology of the female reproductive system in the nonpregnant state.

The combined practice of obstetrics/gynecology is multifaceted and interrelated to other branches of medicine. Therefore, correct differential diagnosis entails a broad base of knowledge in other specialties.

Teaching Curriculum

The curriculum encompasses the scope of contemporary obstetrics and gynecology, and includes the disciplines of obstetrics, perinatology, neonatology, genetics, ultrasonography, gynecology, gynecologic surgery, gynecologic oncology, pathology, endocrinology, infertility, and family planning. Educational conferences include grand rounds with visiting professors, textbook, ultrasound, genetics, oncology, gyn tumor, perinatology, perinatal morbidity/mortality, primary/preventive care, endocrinology, risk-management, ethics and psychosocial conferences. Additionally, there are specialty rotations, postgraduate lectures, out-of-state conferences, and weekly ob/gyn clinics.

The objectives of the teaching curriculum are reflected in the following educational categories: a.) interpersonal communication skills, personal ethics, and attitudes; b.) cognitive knowledge; and, c.) manual skills.

These objectives are further refined into specific goals and educational objectives consistent with the four-year resident manual "Educational Objectives: Core Curriculum for Residents in Obstetrics and Gynecology, Seventh Edition" published by the Council on Resident Education in Obstetrics and Gynecology (CREOG). A manual skills program requires each resident to successfully complete approximately seventy procedures over the course of the four-year program.

Educational Objectives

Interpersonal communication skills, personal ethics and attitudes

Establish effective interpersonal relationships with patients, their families, and other healthcare personnel.

Relate to female patients in an understanding and empathic manner, respect their dignity and individuality, and accept them as participants in decisions regarding their medical care.

Demonstrate sensitivity to patients who have suffered an emotional loss.

Accept responsibility to improve medicine through the personal example of professional excellence, self-discipline, and human concern, even at personal sacrifice.

Exhibit professional integrity and reliability.

Practice medicine that is consistent with local medical licensure laws and regulations and that minimizes the risks of errors in skill or judgment.

Assume responsibility for teaching patients, colleagues, and other health care personnel.

Accept personal responsibility for continued professional growth, develop skills to facilitate the critical review and acquisition of new information, and acquire the habit of continuous study.

Learn the importance of good record keeping as a tool in diagnosing medical problems, managing treatment, and assessing quality of care.

Develop the skills necessary for successful practice management.

Cognitive Knowledge

Demonstrate experience in providing preventive medicine and primary healthcare to women.

Manage normal and high-risk obstetrics.

Treat general gynecologic disease appropriately, both conservatively and/or operatively.

Evaluate and manage obstetrical and gynecological complications.

Evaluate and treat infertility and endocrinology problems.

Diagnose and treat gynecologic malignancies.

Interpret current gyn pathology slides.

Apply genetic historical information in the management of obstetrical patients.

Provide family planning services and counseling.

Understand sexuality and be capable of counseling patients.

Prepare to take the certifying exams of the American Board of Obstetrics and Gynecology.

Manual Skills

Demonstrate skill in performing obstetrical and gynecologic operations.

Demonstrate skill in performing ultrasound examinations.

Diagnose breast disease and perform breast aspirations when indicated.

Maintain accurate records.

Rotation Schedule

The core curriculum of the program entails a hands-on approach to learning. During the first week of training, residents are assigned one afternoon in the clinic and maintain that assignment throughout the four years of training, regardless of their service assignment. Primary responsibility (under supervision) is assumed for all patients under treatment. Since patients are seen continuously by the same resident for four years, the clinic experience closely approximates private practice.

During their night call, residents are responsible for the care of all patients admitted to The Family Birth Center labor/delivery unit and all ob/gyn patients admitted to The Emergency Center. These patients are comprised of staff, clinic and private patients from the community.

A Closer Look

Normal Obstetrics

The major educational objective for the PGY I and PGY II years is the mastery of normal obstetrics. Since residents are assigned to a weekly four-hour clinic at the beginning of their program, they learn normal obstetrics by continuing to care for the same patients over a four-year period. They are continuously supervised by a member of the clinical faculty who observes both patient care and the residents' documentation of that care.

Normal obstetrics is also learned by taking call in the medical center every fourth night. By doing so, residents are exposed to a large volume of obstetrical cases.

High Risk Obstetrics

Since NOMC has a Level III neonatal intensive care unit, a substantial number of deliveries involve high-risk patients. The chief resident of the obstetrics service is responsible for the care of these high-risk patients under the supervision of our faculty. Perinatal consults can be obtained at any time because of our association with the Wayne State University (WSU) School of Medicine. Additionally, the chief residents conduct the weekly perinatology clinic under the supervision of the WSU perinatologist.

High-risk obstetrics is also taught on a weekly basis in the Seminole Medical Center (SMC) where the residents encounter high-risk patients in their own patient population.

Operative Gynecology

The majority of operative gynecology experience is gained during the PGY III and PGY IV years. The chief resident on the gynecology service is responsible for the assignment of all surgical scrubs on the basis of graduated responsibility in terms of the perceived surgical difficulty of the individual case. The gynecology residents then see their assigned patients in the Pre-Op holding area. Each private patient is considered a teaching case and is assigned to and remains the responsibility of a resident until the conclusion of her stay.

Gynecologic Malignancies

Gynecologic oncology faculty are provided through our affiliation with WSU. All gynecologic malignancies are actively treated in NOMC. Our residents have hands-on experience in radical hysterectomy, bowel resection, periaortic node dissection, exposure and repair of ureters, and repair of large and small bowel injury. Both senior residents participate in the weekly oncology clinic.

Since NOMC is the North Oakland County Regional Radiation Oncology Center , our residents evaluate patients being treated with the linear accelerator. Lastly, our PGY III residents rotate on the gyn medical oncology unit at Harper Hospital .

Infertility and Endocrinopathies

Reproductive endocrinology is taught throughout all four years through regularly scheduled educational activities including monthly endocrine conferences, visiting professor conferences, gyn textbook conferences and case/topic presentations. Additionally, ten hours of didactic teaching is included in the OHEP Postgraduate Course.

During the third year, the PGY-III residents spend one-half day a month in NOMC's reproductive endocrine clinic under the supervision of a WSU reproductive endocrinologist, and two half-days a month in the off-site faculty practice office of the endocrinologist. Since both residents participate in this educational activity for one academic year, there is good continuity as they have the opportunity to follow a variety of endocrine/infertility patients for up to one year.

Our residents also learn reproductive endocrinology by rotating one month during their third year at Hutzel Southfield, an outpatient facility of Hutzel Hospital and WSU. The rotation includes exposure to additional endocrine/infertility procedures including assisted Reproductive Technologies.

Genetic Disorders

Clinical genetic experience is gained by rotating one month during the end of their second year at Hutzel Hospital under the supervision of a WSU geneticist. The PGY II residents learn firsthand how to take a genetic history and perform an amniocentesis. Clinical presentations, modes of transmission and risks of various genetic syndromes are thoroughly discussed.

Ultrasonography

During the first year, residents are introduced to ultrasound by spending a one-month rotation with the ob/gyn ultrasonographers. Additionally, an ultrasound machine is kept in The Family Birth Center labor and delivery area for the residents to use to increase their skills.

During the PGY-IV year, the chief residents continue their ultrasound experience by scanning high-risk patients in the perinatology clinic on a weekly basis. They are supervised by a perinatologist with special expertise in obstetrical ultrasound.

Lastly, residents are exposed to ultrasonographic teaching throughout all four years of the program with monthly ob and/or gyn conferences.

Family Planning

Family planning is taught in the SMC Ob/Gyn Clinic. Residents are instructed in the various forms of contraception and the advantages, disadvantages, side effects and possible failure rates of each. They are taught to educate patients and to involve the patient in the final decision.

Sterilization procedures are scheduled through the ambulatory clinic and are supervised by the chief resident on the gyn service and a faculty supervisor. Resident participation in voluntary terminations of pregnancy (VTP's) is elective. Residents who plan to terminate pregnancies in their practice are able to gain clinical experience during the course of the program.

Primary/Preventive Care

Gynecologists are often called upon to provide primary care. Therefore, an understanding of preventive strategies and screening services is imperative for contemporary practice. During the first year, our residents have three months of primary care rotations using both our outpatient facilities, including one of our off-campus primary care medical centers. Additionally, our PGY II residents rotate one month to a geriatric practice.

Postgraduate Lecture Course

The OHEP Center for Medical Education (OHEP), a medical education consortium with which NOMC is affiliated, presents an annual 34-lecture postgraduate course for PGY II residents to enhance residents' understanding of physiology and pathology as it applies to the practice of obstetrics and gynecology. Course instructors also strive to teach the most current concepts in obstetrics and gynecology, reproductive endocrinology, genetics and oncology.

The OHEP course is offered from September to June each academic year. It contains 10 hours of lecture material on anatomy and physiology, 22 hours on pathology (including two hours on cell physiology and cell chemotherapy and two hours on radiobiology and radiation therapy), 12 hours on infertility and endocrinology, 12 hours on obstetrics, six hours on genetics, two hours on imaging techniques, four hours on psychosexual counseling, and two hours on ethics.

Additionally, OHEP conducts an annual oral examination in November for the PGY II and PGY III residents to prepare them for their oral boards. The PGY IV residents are given an oral examination in April based on their senior case lists.

Research

During the four-year program, each resident designs and completes a research project and writes a paper summarizing the results. A research workshop series is presented by the OHEP Research Committee each academic year, providing natural opportunities to evaluate the progress of individual research projects. Workshop I helps residents select a research hypothesis and experimental design, Workshop II gives guidance on project management and statistics, and Workshop III helps residents develop a presentation on the results.

Faculty

The residency program is administered by a full-time program director. All members of the faculty are active, board-certified or board-eligible practitioners of the American Board of Obstetrics and Gynecology. Subspecialists in the fields of gynecologic oncology, reproductive endocrinology, perinatology and genetics are assigned by Wayne State University .