Department of Obstetrics, Gynecology & Women's Health

The residents gain clinical experience at the University of Louisville Hospital (ULH) and at the University OB/GYN Foundation (UGOF), an ambulatory clinic adjacent to the hospital. Additional gynecologic surgical exposure is provided through rotations at other hospitals (OH) in the downtown academic medical complex and at several suburban Louisville and Southern Indiana community hospitals. Most of the residents’ patients are from the University GYN/OB Foundation clinic (UGOF), located in the Ambulatory Care Building (ACB) adjacent to ULH. UGOF is operated by the Department of Obstetrics, Gynecology and Women’s Health and staffed by residents and faculty from the Department. The resident assumes primary responsibility for the patient’s care when seen as an outpatient and subsequently as an inpatient. This is accomplished through a continuity of care clinic established in 1993. Residents are assigned patients whom they see for all four years of their residency. A dedicated night call rotation provides night coverage. In-house faculty coverage provides 24-hour resident support. Weekend coverage is rotated among the non-night call residents. Between 25% and 30% of the training experience is organized around the private patients of the university faculty as well as the private attending physicians in the community. Significant gynecologic surgery is performed during these rotations.

Rotation Overview

*Obstetrics-Days
Days at ULH have a resident from each year, as well as a PGY-3 on the Antepartum rotation. There are also PGY-1 rotators from the ER and Family Medicine residency programs throughout the year. The L&D residents manage all patients in labor, scheduled cesarean sections, post-partum tubal ligations, as well as all post-partum patients on an adjacent wing of the hospital. The intern is primarily responsible for managing Triage patients as well as performing primary cesarean sections, circumcisions, post-partum tubal ligations, and managing laboring patients.

*Obstetrics-Nights
We incorporated an active night rotation several years ago, before the implementation of the 80 hour work-week rule. There are three residents on this rotation: a PGY-1, PGY-2, and PGY-4. The week runs from Sunday night to Thursday night, with weekends free of any other duties. Changeover occurs at 5:30pm and again at 7:30am. During the night, the team manages all Labor and Delivery, Triage, as well as any Gyn cases that present to the ER. At the end of the shift, the team checks out to the day team and participates in the morning didactic sessions from 6:30-7:30am. The night residents have no other call or clinic responsibilities.

*Gynecology-University
University Gyn team consists formally of a PGY-1, PGY-2, and PGY-4. However, the PGY-2 conducts the ODSU rotation (see below) which functions as a separate service. The PGY-1 and PGY-4 perform all the general gynecology and GYN consults at University Hospital. The surgical patient load is obtained from the UGOF clinic.

*Ambulatory Gynecology Surgery (ODSU)
The PGY-2 resident on the General Gynecology rotation performs the ODSU outpatient GYN surgeries. Cases primarily consist of laparoscopy, hysteroscopy, conizations, tubal ligations, and other outpatient cases. The attendings on this service are nationally known for their laparoscopy skills and innovations.
   
*Medicine
The two month Internal Medicine block in the PGY-1 year consists of one month of ward work, followed by one month in the Medical Intensive Care Unit at University Hospital. During these two months, the resident functions as part of the Internal Medicine team and is free from other OB/GYN commitments such as labor and delivery call, with the exception of their weekly continuity clinic and weekly didactic sessions.

*Ambulatory Clinic
The PGY-1 on the Ambulatory Care Clinic rotation sees patients in the scheduled-new-obstetric-patients clinic and general ob/gyn clinic, as well as working three half-days a week at the East Broadway Family Health Center working in general ob/gyn. They also receive directed education in formal ultrasonography.

* Pathology
The pathology rotation is a series of lectures and slide reviews more than a formal rotation. A pathologist with a subspecialty in OB/GYN pathology provides targeted clinical information to the residents.

* Gyn Oncology
There are three GYN Oncologists in the Department. The Gyn Oncology team consists of one resident from each level. Gyn Onc is a very busy service, as the University draws from a large area including Louisville as well as Western Kentucky and Southern Indiana. Residents are responsible for the pre- and post-surgical care of all patients, and as well as those undergoing chemotherapy. All work is hospital based —the PGY-3 resident spends one half-day per week in the Division Director’s private clinics.

*Gynecology-Private
The Private Gynecologic Surgery service includes a PGY-3 and PGY-4, operating at several area hospitals. During this rotation, the residents assist during the major surgical cases of the private physicians who are Gratis faculty members. This rotation provides the residents with the greater part of their benign gynecologic surgery experience. In nearly all of the cases, the resident works officially as the first assist, but also performs the majority of the surgery, functioning as the primary surgeon. The rotation mostly involves gyn surgery cases, with a few obstetric operative deliveries. Some home night pager call is included, but the number of calls is very light. Surgical volume is quite high during this rotation, and it gives the residents an opportunity to operate with several different surgeons allowing multiple viewpoints to familiar surgeries.

* Reproductive Endocrinology and Infertility
This rotation in the PGY-2 year allows the resident to work one-on-one with faculty of the Reproductive, Endocrinology and Infertility Division, seeing patients in the busy PSC clinic who present for various infertility and endocrinology problems. Surgeries are primarily laparoscopic and hysteroscopic and the resident has the opportunity for a great deal of operative experience. The rotation is scheduled to follow the outpatient surgery rotation in which the resident learns their initial laparoscopic skills.

* Antepartum (High Risk Obstetrics)
This rotation is during the PGY-3 year. The Antepartum resident is responsible for the management of antepartum patients as well as participating in High Risk clinics, with some involvement in general Labor and Delivery care. The Antepartum resident participates in formal ultrasound training under the guidance of the Maternal Fetal Medicine specialists.

* Urogynecology
This rotation is during the PGY-2 year and the resident sees patients in both the UGOF Clinic and the Private Urogynecology office. During this rotation, the resident gains significant experience in the diagnosis, evaluation, medical and surgical management of urinary incontinence and voiding problems, pelvic organ prolapse, and other pelvic and urinary dysfunctions. The resident works directly with the Urogynecology Fellow and attendings during both clinic and surgery.