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Curriculum

Educational Objectives

The Sisters Hospital Obstetrics and Gynecology Residency is a progressive, structured educational experience, including formal and informal activities.

The purpose of this program is to teach residents the appropriate basic sciences and clinical skills that will enable them to provide excellent care for women and to fulfill the requirements of the American Board of Obstetrics and Gynecology.

With that goal in mind, specific educational objectives include:

• To create an environment which allows the resident to integrate basic information, technical skills, and sound clinical judgment while at the same time developing the habits of lifelong learning in obstetrics and gynecology.
• To use deductive reasoning in dealing with clinical problems.
• To develop a strong awareness of ethical and intellectual integrity, including the ability to assess one's own progress and limitations.
• To promote the need to serve women with sensitivity, regardless of their socioeconomic background, race or religion.
• To acquire an awareness of socioeconomic and legal factors which impact the practice of obstetrics and gynecology.
• To be able to recognize one's own physical and mental limitations and the impact of stress created by the high intensity learning situation, with an understanding of the potentially deleterious effects of this on one's own personal behavior and ability to appropriately care for patients.

The Elements of Residency

While there is continued emphasis on integrating basic science information into the clinical setting throughout the four years of residency training, the educational objectives include a program of instruction stressing progressive acquisition of cognitive knowledge, technical skills, and professional capability. In addition, there is advancing patient responsibility, culminating in the fourth year.

Each academic year is broken down into 13 modules of 4 weeks each (number in parentheses corresponds to the number of modules spent in each rotation).

There are 13 modules in a year, each composed of 4 weeks. The following represents the rotation schedule of our residents:

Year	OB	Gynecology	Night Float
PGY1	3	2	3	Amb GYN (1)	ICU (1)	NICU (1)	Amb Med (2)
PGY2	3	2	3	MFM (4)	Elective (1)
PGY3	3	3	3	REI (2)	GYN ONC (1)	FLS (1)
PGY4	4	4		MIGS (4)

Key:

• FLS = Fundamentals of Laparoscopic Surgery
• MFM = Maternal Fetal Medicine
• MIGS = Minimally Invasive Gynecologic Surgery
• REI = Reproductive Endocrinology and Infertility

First Year

Emphasis is placed on mastering the fundamental concepts of anatomy, physiology, and pharmacology as they relate to the normal obstetric and gynecological patient. PGY1 residents are closely supervised in the outpatient continuity clinic by a faculty member. During the first year, there are also rotations in internal medicine, outpatient gynecology, neonatal intensive care, and medical/surgical intensive care. First year residents participate in the NCC Fetal Heart Monitoring course and test for certification.

Second Year

During the second year, emphasis is placed on abnormal obstetrics and gynecology with an increase in the level of responsibility and the acquisition of technical skills appropriate for that year. These residents will routinely “run the board” on labor and delivery. They also spend four months rotating in maternal fetal medicine, where they not only see complicated obstetric cases, but also refine their obstetric ultrasound skills. One of these months is spent at Mercy Hospital. One month is available for an elective rotation.

Third Year

More attention is given to the areas of sub-specialization during the third year curriculum (i.e., gynecologic oncology, reproductive endocrinology and infertility, urogynecology and pelvic floor dysfunction, and breast disease). It is also expected that the resident will begin to appreciate the technical refinements that are necessary in a procedure-oriented specialty. Third year residents prepare for and take the Fundamentals of Laparoscopy Surgery (FLS) course and exam, leading to certification. One month of gynecologic oncology is spent at the Roswell Park Cancer Institute. The third year resident assumes a greater role in the teaching of State University of New York at Buffalo (SUNYAB) third year medical students. There is also a month available for an elective rotation.

Fourth Year

During the fourth year of training, there is a strong emphasis on integrating all of the previous years' experience, acquiring additional technical experience and assuming a major role in the responsibility for management of patients with complicated obstetric and gynecological problems. The chief resident must serve as a role model in terms of teaching more junior residents and medical students. The chief resident is also introduced to administrative functions. In the SUNYAB Gynecology-Obstetric Program at Sisters Hospital, one of the chief residents is the administrative chief resident for a period of time and then that responsibility is transferred to another chief resident for an equal amount of time.

All of the chief residents function as junior faculty members, assist in planning educational conferences, deal with appropriate administrative decisions, and interface with the hospital services where the residents interact such as the Emergency Room, Sisters OB/GYN Center and quality assurance.

The Learning Environment

Special BirthPlace

The Special BirthPlace, our labor and delivery unit, is equipped with 2 triage rooms, 10 labor/delivery rooms, 2 operating rooms, and a 3-bed post-operative recovery unit. We have 24-hour coverage by both anesthesiology and neonatology, as well as a level III NICU. Sisters Hospital has nearly 3,000 deliveries every year, and provides ample opportunity in VBAC and operative delivery.

Surgery

Sisters Hospital has over 800 major and 1,400 minor gynecologic cases each year. Our faculty enjoys working with and teaching residents. There is ample experience in abdominal, vaginal, and laparoscopic surgery. We have the DaVinci Si robot, which is used for both gynecology and gynecologic oncology cases, and the residents are trained as assistants for the DaVinci Si. One month of dedicated gynecologic oncology is performed at the Roswell Park Cancer Institute.

Educational Rounds

Every morning at 7 a.m. and every evening at 5 p.m., all in-house residents gather to sign-out their patients. A faculty member is present for these rounds, and varies between an Ob/Gyn, Gyn. Oncologist, Maternal Fetal Medicine specialist, or Internal Medicine attending physician. This gives the residents and the attending an opportunity to talk about patient management decisions and learn how to better care for their patients.

Sisters OB/GYN Center

Sisters OB/GYN Center is the resident outpatient continuity clinic. It is located within Sisters Hospital, and each resident spends one afternoon here each week, with the exception of residents on night float. Residents follow high-risk obstetric patients, as well as see routine and complicated gynecologic patients. Residents perform colposcopy, endometrial biopsy, and minor surgical procedures. Sisters OB/GYN Center serves a largely underprivileged and immigrant population.

Wednesday Education

Wednesday mornings are protected education times for our residents.

After morning sign-out, the time between 8 a.m. and 1 p.m. is reserved for educational activities, including faculty lectures, morbidity and mortality reviews, and CREOG/board exam preparation.

Beeper call is covered by the chiefs during this time.

Night Float

The program utilizes a night float system. Residents on night float work Sunday through Thursday or Monday through Friday nights from 5 p.m. until 7 a.m. The day residents never have to cover weekday night call and only have to take calls on the weekends.

Work Hours

The residency program adheres to the both the ACGME and New York State 405 work hours regulations.

Research

Each resident is expected to develop and conduct their own clinical research project throughout their time at Sisters Hospital. Guidance is provided by a faculty member. This research is to be completed and is presented in the fourth year of residency.

Protocols

Conduct of all house officers is governed by the code of ethics provided by the AMA and the current Ethical and Religious Directives for Catholic Health Care Facilities.