Obstetrics & Gynecology San Francisco - Rotations & Call

OB: Interns perform vaginal deliveries, vacuum deliveries, and cesarean sections. They learn to evaluate fetal wellbeing using internal and external fetal monitors, oxytocin stress tests, non-stress tests, biophysical profiles, and ultrasounds for growth. They also become familiar with epidural and spinal anesthesia methods. Interns join the other Labor & Delivery residents in making postpartum rounds each morning and actively co-manage patients admitted with antepartum complications.

Gyn/Gyn-Onc: Interns perform most minor procedures, such as dilation and curettage, laparoscopic tubal ligation, and diagnostic laparoscopy. They also have the opportunity to scrub with other residents on more advanced surgical cases. First year residents learn to provide pre-and post-operative care for patients with both benign and malignant gynecologic conditions. Interns carry the gynecology consult phone, allowing them to evaluate patients in the emergency room.

Specialty Clinics: These three months provide an introduction to the outpatient practice of both generalists and sub-specialists. Interns establish their own continuity clinic and have special one-on-one proctoring. Subspecialty clinic experiences focus on: HROB, GYN and GYN Oncology. Interns may also gain experience in REI, adolescent/pediatric gyn, teen ob clinic, menopause, and chronic pelvic pain.

ICU & ED: Interns spend 2 weeks in the intensive care unit and 1-2 weeks in the Emergency Department. These rotations provide valuable education in managing medically complex patients in an ICU setting and acute patients presenting to the ED. Residents work side by side with IM and ED residents and are supervised by intensivist and ED faculty.

Night Float:  During these two months, interns truly master how to “run the board” on Labor & Delivery, as well as manage a busy triage. By the end of the intern year, most interns have done nearly 130 vaginal deliveries and 50 cesarean sections (both primary and repeat).

Ob: The second-year residents run the labor and delivery floor under the supervision of the senior resident and faculty physicians. They perform more difficult cesarean sections and operative deliveries and manage more complicated antepartum patients. They also share in the responsibility for teaching medical students.

Gyn/Gyn-Onc: Second-year residents learn to perform hysterectomies and myomectomies, operative laparoscopy, diagnostic hysteroscopy and cystoscopy. They provide care for patients on both the benign and gyn-onc service. They develop more autonomy in evaluating ER patients, with the support of senior residents and faculty.

Specialty Clinics: Residents see more complex patients and do a greater number of procedures in their continuity clinics. They spend more time rotating through specialty clinics, with focused attention to: Urogynecology, Complex Family Planning, Reproductive Endocrinology and Infertility, and Ambulatory Gynecology.

Transgender Health Care and Advocacy: Residents will focus on learning to provide comprehensive surgical and medical care for transgender patients. This rotation will build upon prior earlier learning experiences in the multi-disciplinary gender pathways clinic in the first year. This experience will include counseling, pre-op/post-op, surgery, and hormone consultations. As part of our longitudinal Advocacy curriculum, residents on this rotation will identify an advocacy project and mentor to be completed by graduation.

Night Float: In addition to having a greater role in managing Labor and Delivery, second-year residents care for the gynecology patients overnight and see all emergency room patients. This provides them with the opportunity to perform urgent gynecologic surgeries if the need arises.

Ob: Residents care for increasingly complicated antepartum and laboring patients and assume more teaching responsibilities for junior residents. Residents also have the opportunity to perform cerclages and breech extractions of second twins.

Kaiser WCR: Three months are spent in Kaiser’s Diablo Service Area, centered at Kaiser Walnut Creek. This allows the resident to perform a large number of diverse gynecologic surgeries including vaginal, abdominal and laparoscopic hysterectomies, incontinence procedures including TVT and TOT, and prolapse procedures such as vaginal repairs, abdominal sacrocolpopexies and colpocleises. Night call is focused on helping manage a busy labor and delivery.

Specialty Clinics and Jeopardy: Senior residents continue to manage their continuity clinics and increasing procedure clinics during their 3 months of Specialty Clinic and 1 month on Jeopardy. They also attend sub-specialty clinics, focusing on: Complex Family Planning; Urogynecology, HROB, and Gyn-Onc. During Jeopardy months they also assume chief responsibilities for services when PGY4’s are away.

Night Float: This is a senior leadership role managing Labor and Delivery, providing care to in-patient gynecology patients and emergency room consultations. The first month the PGY3 oversees and PGY2 and then in the second month further leadership maturation occurs while supervising a PGY1.

Elective: This no-call elective experience is driven by the individual resident’s needs, interests, gaps and passions. There is global health funding available, though residents may choose to pursue an experience locally or anywhere in the United States.

During this unique year, fourth years assume the role of “chief” for 3-month blocks of time on the four services listed below. They meet weekly with the program director to discuss the state of each service and focus on leadership training, resident education, and program development. Chiefs also plan the resident retreat, a consistent highlight of the year.

Ob:  Chiefs are responsible for: managing antepartum, intra-partum, and postpartum services; and teaching junior residents and medical students. They attend Maternal Fetal Medicine clinic weekly. In the operating room, they function as Teaching Assistants taking junior residents through cesarean sections with the supervision of faculty physicians.

Gyn:  Chiefs assume responsibility for all pre- and postoperative patients and other gynecology inpatients; for teaching junior residents and students; and for performing the most complicated gynecologic surgeries. They organize a monthly preoperative conference and are responsible for coordinating morning teaching.

Gyn-Onc: Chiefs work very closely with the gynecologic oncologists faculty and fellow. They assist to provide clinic preoperative care, operate on all gynecologic oncology patients and are responsible for the work-up and postoperative management of these patients. They are also responsible for monthly presentations at tumor board.

SFO Clinic and SSF Minimally Invasive Surgery:  Residents serve as administrative chief residents during the three months of this rotation. They organize teaching for the clinic and gynecology residents and schedule all resident and medical student clinics. They have increased number of continuity and procedure clinics. Approximately a third of the time the chief is at South San Francisco performing benign surgical procedures, mostly advanced laparoscopic hysterectomy and vaginal hysterectomy.