The four years of residency are a continual progression of increasing knowledge, skills, professionalism and the development of a strong sense of responsibility for the entire healthcare team.
The first-year residents start by mastering the fundamental concepts of anatomy, physiology, and pharmacology as they relate to the normal obstetric and gynecological patient. The interns are closely supported by the Chief Resident(s) and supervised in their continuity clinic by a core faculty member. During the first year, there are also rotations in neonatal intensive care, primary care, family planning and adult intensive care. The less demanding outside rotations provide time to study and take the USMLE/COMLEX Step III. First-year residents obtain NCC certification in electronic fetal monitoring, the CLEAR certification from the Perinatal Quality Organization and complete the Neonatal Resuscitation Program.
During the second year, emphasis is placed on high-risk obstetrics with rotations in ultrasound and maternal-fetal medicine. The second-year residents learn how to “run the board” in Labor and Delivery with the support of their Chief Resident and in-house Supervising Attending Physician. The PGY-II residents spend a dedicated month developing their obstetric ultrasound skills during the SONO rotation, which includes completion of the Thomas Jefferson University Ob/Gyn U/S Online Classroom series. These skills and knowledge can then be applied to help manage the antepartum service while on MFM. Several graduates have found that they have had enough ultrasound experience to sit for and pass the Registered Diagnostic Medical Sonographer exam. The middle of the second year contains an entire module devoted to Research and Quality and Patient Safety (QPS). This rotation provides each resident with protected time to collect data and prepare their abstract. It also allows the resident to gain insight into the workings of the hospital system as they participate in QPS activities. At the end of the year, the focus turns to preparing for advanced gynecologic surgery with an entire month devoted to surgical education and simulation training at the Applied Technology Laboratory for Advanced Surgery (ATLAS) at Roswell Park Comprehensive Cancer Center (RPCCC). This time includes on-line introduction to the da Vinci Surgical System, didactic and hands-on preparation for the Fundamentals of Laparoscopic Surgery certification exam, robotic surgical simulation with both dry and porcine labs, opportunities to observe expert robotic surgeries and time on the da Vinci surgical simulator.
The third-year resident shifts his or her attention from obstetrics to the areas of gynecologic surgery, oncology, reproductive endocrinology and infertility. The third year includes two modules on the Gyn Oncology service at the Roswell Park Comprehensive Cancer Center. The resident is an active member of the team that includes fellows and attending gynecologic oncologists who are active in research and clinical trials. Learning the national standards for cancer care and increasing operative experience are important aspects of the resident’s time at Roswell Park. Each resident spends two modules with the Buffalo IVF and Infertility group. This experience includes two days a week in the operating room and two days in the office participating in outpatient consultations and learning about assisted reproductive technologies. The third post-graduate year is further enhanced by exposure to new surgeons at Mercy Hospital of Buffalo. This experience augments the resident’s surgical tool kit with new techniques and approaches while helping to ensure that all residents reach their ACGME case log minimums. The third-year resident assumes a greater role in caring for the sick gynecologic patients and the teaching of the medical students.
During the fourth year of training, there is a strong emphasis on integrating all of the previous years' experience, acquiring additional technical skill and assuming a major role in the formulation and execution of management plans for all patients. This is especially true for the Sisters Ob/Gyn Center (Staff) patients.
The Ob Chief Resident facilitates morning report and evening sign-out. He or she rounds daily with the in-house Supervising Attending Physician on all staff patients. The Gyn Chief Resident assigns coverage for all surgical cases and takes the lead on the oncology service, which includes regular contact with the gynecologic oncologists who practice at Sisters of Charity Hospital. The MIGS Chief operates and attends office hours with Dr. Ali Ghomi, the Director of Robotic Surgery, who is board certified in Female Pelvic Medicine and Reconstructive Surgery. As part of their Systems-based Practice education, the Chief Residents are required to actively participate in the Peer Review process by presenting cases at the monthly meetings and working with the Maternal-Child Safety Committee to foster communication and best practice in our department.
The Chief Residents serve as role models for the junior residents and medical students while taking ownership of the service by coordinating care and advocating for the patients. An important part of the final year of training is taking responsibility not only for one’s own performance but for the performance of the entire team.
The academic year is divided into thirteen (13) four-week modules per year. The following represents the rotations for our residents:
|PGY Level||OB||GYN||Nights||MFM||SONO||Research QPS||Atlas||RPCI||REI||Mercy GYN||MIGS|
*One module each of NICU, Primary Care, Family Planning, ICU.
QPS = Quality and Patient Safety
ATLAS = Applied Technology Laboratory for Advanced Surgery Training Program at RPCI
MFM = Maternal Fetal Medicine
RPCI = Roswell Park Cancer Institute
REI = Reproductive Endocrinology and Infertility
MIGS = Minimally Invasive Gynecologic Surgery
The Learning Environment
The Special Birth Place, the moniker for our Labor and Delivery unit, assists with over 3,200 deliveries each year and provides the full range of obstetrical care - from patients seeking a natural birth experience to high-risk patients with multiple comorbidities requiring an interdisciplinary team. Approximately 750 of these patients receive their prenatal care in the Sisters Ob/Gyn Center, where the residents see patients as part of their longitudinal care experience. Labor and Delivery was remodeled in 2019 and includes a brand-new triage area with six triage rooms, a physician work area, twelve labor/delivery suites, two operating rooms, and a three-bed post-operative recovery unit. We have 24-hour in-house coverage by both anesthesiology and neonatology. Our Level III NICU attracts transfers from across Western New York.
Sisters of Charity Hospital performed over 2,000 gynecologic cases, including hysterectomies, in 2018. There is ample experience in abdominal, vaginal, and laparoscopic surgery. Our faculty enjoy teaching and working with our residents. We have the da Vinci Xi Surgical System at our Main Street Campus and the Si platform at our St. Joseph Campus. Mercy Hospital, where the third- and fourth-year residents operate, has two robots. Roswell Park Comprehensive Cancer Center, where the third-year residents spend two modules, has multiple da Vinci Surgical Systems used in the treatment of gynecological malignancies. The residents progress through a pathway of training with the goal of being credentialed to perform robotic-assisted procedures upon graduation.
Morning Report is every weekday at 07:00 and Sign-Out is every evening at 17:00. All in-house residents gather in the Ob/Gyn Learning Center with the in-house Supervising Attending Physician to present their patients. This gives the residents and the faculty an opportunity to discuss diagnosis and management plans and optimize patient care. The Learning Center was recently remodeled to include a Smart Board, live feed of the labor board and fetal monitor strips, multiple computer work stations and a kitchen space. The morning session promotes educational discussion while the evening session focuses on a safe patient hand-off. In the evening, the Gyn team presents first and is dismissed at 17:15 each day. Listrunner provides an electronic patient list that allows residents to keep each other updated and is accessible via the internet.
Sisters OB/GYN Center
The Sisters Ob/Gyn Center is the residents’ outpatient continuity clinic. It is located within Sisters Hospital, and each resident spends one half-day session there each week. Residents on Nights are excused. Third-year residents rotating at RPCCC and Chief Residents on Gyn are also excused when they have surgical cases of interest like vaginal hysterectomy. Residents follow high-risk obstetric patients as well as see routine and complicated gynecologic patients. Residents perform colposcopy, endometrial biopsy, saline-infusion sonography and other minor surgical procedures. Sisters Ob/Gyn Center serves a largely underprivileged and immigrant population.
Wednesday morning is protected time for our residents. After morning report, the time between 08:00 and 13:00 is reserved for educational activities. The Academic Calendar includes didactic lectures from core and guest faculty, CREOG exam preparation, M&M Conferences, review of ACOG Practice Bulletins and multidisciplinary meetings to discuss our high-risk patients. Faculty handle emergencies so that the residents can focus on education. The resident educational experience is augmented by Journal Club, which meets eight (8) months out of the year. Each resident presents once throughout the course of the academic year. These meeting are held over dinner immediately following evening sign-out. Residents also participate in emergency drills, multidisciplinary work groups and committees as well as case conferences. Since the residents are an integral part of the Ob/Gyn care delivered at our hospital, they are active contributors to our system-based practice (Maternal-Child Safety Committee) and quality improvement process (Peer Review, Root Cause Analysis).
Call and Duty Hours
The program utilizes a night float system. Residents on Nights work five (5) nights in a row - usually Sunday through Thursday from 17:00 until 08:00. The day residents take call on the weekends and holidays. Day residents who are on call typically work 24 hours on Friday or 24 hours on Saturday or 12 hours on Sunday. While on call, residents cover L&D, take calls from the antepartum, postpartum and gyn floors and also provide consultation for the Emergency Room. We try to maximize the number of weekends completely off. Including weekends off during Nights and vacation, each junior resident has 20-plus weekends off each year. Chief residents have 30 such weekends.
The residency program adheres to both the ACGME and New York State 405 work hours regulations. Residents work no more than 80 hours per week and have one complete day off every 7 days. The average hours worked for all residents during a typical academic year is 65 hours per week. All residents receive four weeks of vacation and accrue sick time per the policies of the Office of Graduate Medical Education at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.
Each resident is expected to develop and conduct his or her own clinical research project or similar scholarly activity throughout their time at Sisters Hospital. Residents are encouraged to submit a complete abstract to a national or regional organization for presentation at their annual meeting. These trips are supported financially by the hospital. Some projects will be worthy of publication and should be submitted by the beginning of the fourth year. Guidance is provided by a faculty mentor. This research is to be completed and is presented in the third and fourth year of residency.
A sampling of recent publications from our residents and faculty include:
- Nolan W, Ohaeri H, Georger L, Ghomi A. Robotic-assisted laparoscopic Essure removal: a novel surgical approach. Journal of Robotic Surgery. 2020 Nov 25. https://doi.org/10.1007/s11701-020-01176-2. Epub ahead of print. PMID: 33237557.
- Thomas Guttuso, Susan Messing, Xin Tu, Patrick Mullin, Rachel Shepherd, Chad Strittmatter, Sumona Saha, Loralei L. Thornburg. Effect of gabapentin on hyperemesis gravidarum: a double-blind, randomized controlled trial. American Journal of Obstetrics & Gynecology MFM. 2020;XX:x.ex–x.ex. https://doi.org/10.1016/j.ajogmf.2020.100273.
- Ghomi A, Nolan W, Rodgers B. Robotic-assisted laparoscopic tubal anastomosis: Single institution analysis. International Journal of Medical Robotics. 2020 Aug 27:e2155. https://doi.org/10.1002/rcs.2155. Epub ahead of print. PMID: 32856401.
- Michaela Behrens, Michael Licata, Ji-Young Lee. The infected hematometra in a rudimentary noncommunicating horn misdiagnosed as pelvic mass: A case report. International Journal of Surgery Case Reports. Volume 68, 2020: 4-7. https://doi.org/10.1016/j.ijscr.2020.01.052.
- Jennifer J. Barr, M.D., Lindsey Marugg, M.D. Impact of Marriage on Birth Outcomes: Pregnancy Risk Assessment Monitoring System, 2012–2014. The Linacre Quarterly May 10, 2019. https://doi.org/10.1177/0024363919843019
- Jaron Mark, MD; Deanna M. Argentieri, PharmD; Camille A. Gutierrez, BS; Stacey Akers, MD; et al. Ultra-restrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery. JAMA Network Open. 2018 Dec; 1(8): e185452
- Sanderson, D.J., Sanderson, R., Cleason, D., Ghomi, A. Manual morcellation compared to power morcellation during robotic myomectomy. J Robotic Surgery (2018). https://doi.org/10.1007/s11701-018-0837-y
- Barr JJ & Caruso-McEvoy. Validation of the Postpartum Social Support Questionnaire in low-income, African American women. J Family Social Work 2018; 21(4-5): 413-230.
- Eng KH, Morrell K, Starbuck K, Spring-Robinson C, Khan A, Cleason D, Akman L, Zsiros E, Odunsi K, & Szender JB. Prognostic value of miliary versus non-miliary sub-staging in advanced ovarian cancer. Gynecologic Oncology 2017; 146(1):52-57.
- Sanderson DJ & Ghomi A. Robot-assisted laparoscopic myomectomy: a comparison of techniques. J Minim Invasive Gynecology 2015;22(6S):S18.
- Sanderson DJ & Ghomi A. Bilateral obturator neuropathy after transobturator vaginal sling: a case report. Female Pelvic Med Reconstructive Surgery 2015;21(2):e21-2.
- Ghomi A, Kramer C, Askari R, Chavan NR, & Einarsson JL. Trendelenburg position in gynecologic robotic-assisted surgery. J Minim Invasive Gynecol. 2012;19(4):485-9.
Our program is committed to building resident resiliency throughout the four-year journey of training. We have an annual retreat that allows the entire house staff to come together for team building and bonding. In 2017 we instituted quarterly wellness days that include time off for medical and dental appointments, lectures on nutrition, self-care, mindfulness, a provided lunch and time for the residents to huddle as a team. During the 2018-2019 year, we participated in the CREOG wellness curriculum pilot.
Conduct of all house officers is governed by the Standards of Behavior for Catholic Health, the policies and procedures of the University at Buffalo Office of Graduate Medical Education, the code of ethics provided by the American Medical Association and the current Ethical and Religious Directives for Catholic Health Care Facilities.