General Organization of the Categorical Residency in Reproductive Medicine
The residency consists of four years of intensive clinical training in general obstetrics and gynecology, including formal training in all four of the recognized subspecialties: oncology, perinatology, reproductive endocrinology, and urogynecology. Residents are selected with the expectation of completing the entire four years.
The team approach is an intrinsic part of the training program. The obstetric, gynecology, and gyn oncology services are each headed by a separate chief resident, who, in consultation with the appropriate faculty member, is responsible for the care of patients on his/her service. Working with him/her are a defined number of house staff who are specifically assigned to the team. Responsibility for individual inpatient care is delegated to junior house staff by the chief resident on a graduated basis in accordance with the resident's level of training and competence. Ultimate direction of the service is the responsibility of the appropriate chief resident.
In the outpatient setting, the team approach is continued. However, in this setting each resident is expected to follow his/her own patients. This is facilitated by careful planning of the schedule so that throughout the year (even while on rotation to other services or hospitals), residents have weekly assigned continuity clinics to follow their own patients at UCSD Medical Center. This permits the early establishment of physician responsibility for patients, provides for follow up, and results in better doctor-patient relationships.
The total residency is designed so that at the completion of four years, the physician will have had a good balance of general obstetrics-gynecology, reproductive subspecialties, and primary care medicine.
Resident obstetrical-gynecological (continuity) clinics are scheduled every morning and afternoon, Monday through Friday, with the exception of Wednesday afternoon, which is reserved for didactic conferences. Departmental clinics include general obstetrical-gynecological clinics as well as specialty clinics in high-risk obstetrics, diabetic obstetrics, genetic amniocenteses, ultrasound, oncology, reproductive endocrinology-infertility, urogynecology, and colposcopy. Residents on the various services are routinely assigned to these specialty clinics and play an integral role in the care and management of the patients.
The obstetric service at UCSD Medical Center in Hillcrest consists of a labor and delivery unit which currently has 8 LDR rooms, a triage area, 3 operating rooms and a recovery room. This unit is undergoing expansion and renovation. The postpartum floor has 24 beds, and there is a high risk antepartum unit as well. The entire labor and delivery suite (including the antepartum rooms) has centralized fetal monitoring and electronic patient care documentation. There is 24-hour, full-time anesthesia coverage to the obstetrical service and full-time coverage by a perinatologist, as well as in- and outpatient lactation services. In addition, there is a birth center where low risk midwifery deliveries take place.
On the gynecology and gynecologic oncology services, patients can be followed at either Hillcrest or Thornton hospitals, where state-of-the-art operative and medical care is provided on an in- or outpatient basis. On both services, the faculty preside at daily teaching rounds and provide consultative interaction throughout the day. Nearly all surgical cases are performed by the resident staff, under faculty supervision.