Program Information :: Brigham and Women's Hospital/Massachusetts General Hospital I...

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Program Information
Thank you for your interest in learning more about our Obstetrics/ Gynecology residency training program. The four-year training period is organized into ten or eleven rotations per year at our parent institutions, Brigham and Women's Hospital and Massachusetts General Hospital, and affiliated institutions including Newton Wellesley Hospital, Children's Hospital Boston, South Shore Hospital and North Shore Medical Center (Salem Hospital). We also have the support of Harvard Medical School , and access to its many resources including the Countway Electronic Library of Medicine. Educational Mission At the end of our program, our residents will have demonstrated achievement in the following areas: Competency in the provision of surgical, medical and ambulatory health care for women. Ability to effectively educate his/her patients, medical students, colleagues, and others in the health care profession as well as lead medical teams. An awareness of cultural competence, with clear understanding of the psychosocial responsibilities of an obstetrician-gynecologist as a part of the greater community as a whole. Competence in advanced surgical skills, with the knowledge and technical abilities to manage both routine and unusual problems in Obstetrics and Gynecology. Participation in clinical and/or basic science research; most residents contribute this new knowledge in the arena of women's health through the dissemination of their research in national forums. Knowledge and comfort with the various subspecialties, with an appreciation of reasons for referral of patients who would benefit from additional expertise. The development of tools to critically analyze the medical literature, and a commitment to lifelong learning with personal responsibility toward one's own continued education. Competence (as consistent with one's personal and moral conviction) in the surgical and medial management of first and second trimester pregnancy termination, and the ability to manage complications of abortion. Facility with the management of gynecologic and psychosocial problems of a pediatric and adolescent population. An understanding of the importance of informed consent, documentation and practice of a code of medical ethics that challenges each resident to strive for professional excellence, self-discipline, and human concern in his/her practice of medicine. Clinical Training Brigham and Women's Hospital and Massachusetts General Hospital are large teaching institutions with considerable involvement of residents and medical students in all aspects of patient care. The clinical environment is one of high acuity and high patient volume that provides our residents

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with outstanding clinical training. There is a progression of responsibility with each year of training designed to focus on clinical and leadership development . Obstetrics: Approximately 40 percent of all births in the City of Boston will occur at Brigham and Women's Hospital and Massachusetts General Hospital . There are approximately 8000 and 3500 deliveries per year at BWH and MGH, respectively. Residents on the service manage all inpatient obstetrical experiences with direct supervision from the faculty. Delivery suites are supported by a full-time obstetrical anesthesia service, ultrasound, central electronic fetal monitoring, blood gas laboratory, and full blood bank services, with over 35 combined LDR's and 6 cesarean section suites. Both services have antepartum units and intrapartum facilities, as well as resources for tertiary maternal, fetal, and newborn care. Approximately 30 percent of obstetrical patients have special risk factors or are emergency transfers. Both services accept neonatal and maternal transports. Gynecology: The gynecologic service at BWH has four committed major operating rooms, two minor operating rooms and 25 beds, while MGH has two committed major and same-day surgery operating rooms and 18 gynecologic beds. There are approximately 7000 and 2300 gynecologic surgical procedures performed per year at BWH and MGH, respectively. Gynecology patients are distributed with faculty OBGYN Generalist practices at both institutions, as well as a large independent practice staff at BWH. All of the gynecology cases are available for residents, with the degree of responsibility being dependent upon the level of training of the assigned resident. In addition, family planning and pregnancy termination services are provided at both institutions. Residents also participate in general gynecologic surgery at North Shore Medical Center (Salem Hospital) or South Shore Hospital in the PGY 2 year and advanced laparoscopic surgery, urogynecology and general gynecology during their Newton Wellesley Hospital rotation in the PGY 3 year. Minimally Invasive Surgery: Advanced minimally invasive abdominopelvic procedures are now performed at all of the sites affiliated with our training program. Some of the more commonly performed procedures include total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic myomectomy, laparoscopic sacrocolpopexy, laparoscopic surgical treatment of advanced endometriosis and a full range of hysteroscopic procedures. Brigham and Women's Hospital developed a Minimally Invasive Gynecology Surgical Center in 2006 dedicated to performing advanced laparoscopic and hysteroscopic procedures. Members of the division also perform laparoscopic abdominal cerclage, laparoscopic uterine artery occlusion, and laparoscopic presacral neurectomy. All of the gynecology cases are available for residents, with the degree of responsibility being dependent upon the level of training of the assigned resident . At the NewtonWellesley Hospital Minimally Invasive Gynecology Surgical Center, over 500 advanced laparoscopic and hysteroscopic surgical cases are performed annually. Residents participate in this surgery during a dedicated rotation in the PGY 3 year. Both centers are highly committed to teaching and have laparoscopic simulators available for resident teaching, and basic skills tasks at which residents must demonstrate proficiency during certain gyn surgery rotations. Gynecologic Oncology: Gynecologic cancer is managed by the gynecologic oncologists with multidisciplinary support from radiation therapy, medical oncology, and pathology. The Divisions of Gynecologic Oncology at both institutions are comprised of full-time faculty , and residents participate in ambulatory sessions as well during these rotations. Approximately 500 new cancer patients are seen annually at BWH and MGH, representing the full spectrum of gynecologic malignancies. There are approximately 400 major surgical oncology cases at MGH and 700 at BWH annually. All treatment modalities are available at both hospitals, including radical surgery, radiation therapy, chemotherapy, and immunotherapy. Both institutions are increasingly performing more minimally invasive surgery for treatment and staging of endometrial cancer, lymph node dissections, radical hysterectomy and complicated benign conditions including advanced endometriosis. Reproductive Endocrinology/Infertility: The Reproductive Endocrinology and Infertility practices at both sites have resident participation with patients being evaluated by faculty members in both the ambulatory and inpatient settings. Residents participate in outpatient management of infertility, complicated endocrine disorders, leiomyomas, chronic pelvic pain, and endometriosis. Residents participate in operative cases for infertility and reproductive endocrine patients, including advanced operative hysteroscopy and laparoscopy cases. Pediatric/Adolescent Gynecology: Children's Hospital Boston has a strong base of referrals of complex cases involving congenital anomalies and high acuity pediatric and adolescent gynecology. Additionally, there are a significant number of educational opportunities in ambulatory adolescent community gynecology. The patients represent an ethnically diverse population traveling from throughout the United States to see specialists at Children's Hospital Boston. The ages represented in this pediatric and adolescent population span from birth to 23 years of age. Residents see all patients with an attending physician, and all cases are available for resident involvement. Residents participate fully in all of the surgery of the Pediatric and Adolescent Gynecology specialist under direct supervision. Family Planning and Abortion: Pregnancy termination services are offered at the BWH Family Planning Center and Women's Health Services for pregnant women in both the first and second

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trimesters up to 23 6/7 weeks. The approximate numbers of procedures occurring annually are 330 first trimester and 70 second trimester terminations at the Family Planning Center at BWH and 3300 first trimester and 500 second trimester terminations at Women's Health Services. Residents with moral or ethical reasons may opt out of performing elective abortion, however, must learn the management of complications from abortion, and do so through conferences/didactics, and consultation on patients presenting to the ED and ambulatory clinics. Ambulatory Services: Both Brigham and Women's Hospital and Massachusetts General Hospital provide services to a large population of patients who receive care in ambulatory settings onsite, in satellite offices, and in neighborhood health centers. Residents in the PGY 2, PGY 3 and PGY 4 years participate in a gynecology continuity practice, following a panel of patients throughout the three years. Additionally, an obstetric continuity clinic was instituted for PGY 1 residents in 1998. The Brigham and Women's Hospital ambulatory services records approximately 74,000 outpatient visits per year for General Obstetrics and Gynecology, Reproductive Endocrinology, Maternal-Fetal Medicine, Gynecologic Oncology, and Urogynecology. In addition, there is the Center for Fetal Medicine that offers prenatal diagnosis, obstetric ultrasound, fetal assessment, consultative services and genetic counseling. The Massachusetts General Hospital sees over 100,000 ambulatory patients per year in General Obstetrics and Gynecology, Reproductive Endocrinology, Maternal-Fetal Medicine, Gynecologic Oncology, and Urogynecology. The ambulatory care services are all provided in the newly constructed Yawkey building that opened in October 2004. The residents have primary patient care responsibilities, under the supervision of the faculty, in the BWH Obstetrical Continuity Clinic and the BWH and MGH Gynecology Continuity Clinics. The resident obstetrical continuity clinic at the BWH has approximately 3000 patient encounters annually. The resident gynecology clinics at BWH and MGH have approximately 5300 and 6500 annual outpatient encounters respectively. Residents see a diverse population of patients with all types of health insurance, including private insurance (approximately 20%), Medicare and Mass Health (50%) and Freecare (30%). The resident clinic practices reflect the city's ethnic diversity. There is a large Spanish-speaking population, as well as Asian, Haitian, African, Russian, and European patients. Patients are referred from the community to the resident practice much like a community health center. Additionally, problem-based referrals are received from the hospital internal medicine and specialist practices and from other outlying health centers. Academic Training The mainstay of the academic training is our core didactic program (see separate section on Didactics). This includes weekly Grand Rounds at both parent institutions, faculty led didactics, Obstetrics and Gynecology simulation activities, journal club, ABOG's Life Long Learning program, Morbidity and Mortality and Multi-disciplinary Cancer Conferences. Residents have protected didactic learning time on Wednesdays from 7:30 AM to 1:00 PM at BWH, and on Thursdays from 7:30 AM to 9:30 AM at MGH. Annual didactics include participation in the Obstetric Simulator, cadaver anatomy course, epidemiology and statistics course, IUD training, Intern Boot Camp and hysteroscopy/laparoscopy courses. The didactic curriculum is based on the CREOG Learning Objectives in Ob/Gyn and core topics rotate every one-two years to facilitate resident exposure during their residency tenure. There are many resources available to our residents to foster academic development within our departments and throughout the institutions. Residents have designated study areas at BWH (Abramson Library and the Labor and Delivery resident Teaching Room), and MGH (Yawkey 4) with essential texts and practice models including laparoscopic trainers. Internet access, Partners applications, MEDLINE, Up-to Date, and Micromedex are available at every computer terminal. All residents have access to department libraries and hospital libraries 24 hours a day, with unrestricted hours at MGH's Treadwell Library, BWH's Medical Library and Harvard Medical School 's Countway Library of Medicine. A medical librarian at both MGH and BWH is available to assist with MEDLINE searches and article retrieval. Our goal is to educate the next generation of world-class clinicians, and leaders in women's health. We take pride in the training program we offer, while continually striving to improve upon it, and are proud of our graduates who serve as leaders in our field. We hope you will consider our program for your education. If there is any information that you do not find on the website, please call the residency office and we would be happy to answer any other questions you may have. Thanks again for your interest in our program, Ruth Tuomala MD Residency Program Director Brigham and Women's/Massachusetts General Hospital Integrated Residency Training Program in Obstetrics and Gynecology Joan Bengtson, MD Associate Residency Program Director for Brigham and Women's Hospital Samantha Pulliam, MD

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Associate Residency Program Director for Massachusetts General Hospital

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