Curriculum

Curriculum

The overall philosophy of our Obstetrics and Gynecology Residency Training Program is to create an environment that provides formal instruction and constructive evaluation as well as increasing levels of experience and responsibility from the earliest levels of training onward.

Our curriculum provides residents with comprehensive clinical and didactic learning experiences.

 


Clinical Training Structure

 

All patients - whether service or private, including patients seen in the outpatient department, admissions, surgeries, and deliveries - are available for resident education. In addition, the department strives to create an environment of research and scholarly activity that optimizes the academic efforts of all members of the department and encourages a life-long commitment to the pursuit of knowledge.

In addition to the opportunities available within the department itself, our residents obtain additional educational experiences from rotations outside the department. These include rotations in the outpatient internal medicine clinics, Family Medicine, the Emergency Department, and Anesthesia.

In addition, residents are given one month of elective time where they may schedule an in-house or off-site rotation to complement their educational experience.

Beginning in the first year of training, residents attend a half-day continuity clinic session each week in the outpatient clinics. These sessions consist of two to three residents and a supervising faculty attending. Attendings do not have other responsibilities or see other patients while supervising residents. Each resident follows his or her complement of patients under the supervision of a faculty attending. As residents advance in their training, the number of patients they oversee will increase.

In addition to the continuity clinic sessions, residents will rotate through departmental specialty clinics, including high-risk obstetrics, urogynecology, oncology and reproductive endocrinology and infertility.

The outpatient clinics are located in a large, renovated space equipped with a procedure room, 6 examination rooms, 2 consultation rooms, and a conference space with library and computers. Procedures performed include colposcopy, LEEP, cryotherapy, endometrial sampling, complex cystometrics, cystoscopy, and office hysteroscopy. A mobile ultrasound with abdominal and endovaginal probes is available for use in each evaluation room.

For more information:

 

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Department Organization

From routine gynecologic examinations and high-risk obstetrical services to urogynecologic treatment and advanced surgical procedures, our Department of Obstetrics and Gynecology offers advanced and compassionate care to women, children and infants. The department's obstetricians and gynecologists provide comprehensive care throughout all stages of a woman's life. Residents actively participate in the evaluation and management of these patients under supervision of the subspecialist. The department is organized into the following divisions, each offering the resident unique educational experiences in obstetrics and gynecology:

 

Ambulatory Obstetrics & Gynecology Program

Faculty
Aurora M. Miranda, MD
Roseann Covatto, MD

West Penn Hospital's Ambulatory Obstetrics and Gynecology Program is staffed by a board-certified obstetrician/gynecologist who is also a member of the hospital's full-time faculty, and by board-certified private practice obstetrician/gynecologists. The mission of the Ambulatory Obstetrics and Gynecology Program is to provide a service-oriented continuing care clinic for the patients the hospital serves, as well as to offer clinical obstetric management and office and practice management training to residents. Consultations with the obstetrics and gynecology faculty and with specialists in internal medicine, surgery, radiology and emergency medicine are available at all times. The Ambulatory and Obstetrics Gynecology Program offers the following services:

  • Pediatric, adolescent, reproductive, menopausal and geriatric gynecologic care
  • General obstetrics and gynecology care
  • Family planning
  • High-risk obstetric care
  • Colposcopy
  • Reproductive endocrinology and infertility services
  • Urogynecology services
  • Gynecologic oncology care
  • Minor gynecologic surgery
  • Level I ultrasound

 

[Dept. Organization]

 

Division of Gynecologic Oncology

Faculty

Fredric V. Price, MD, FACOG, FACS, Director

Thomas C. Krivak, MD, FACOG, FACS

Eileen M. Segreti, MD, FACOG, FACS

A. Dwayne Jenkins, MD, FACOG

Stephanie Munns, MD

Gynecologic oncology is the subspecialty of obstetrics and gynecology that deals with all aspects of cancer of the reproductive organs in women. Our Division of Gynecologic Oncology provides comprehensive care to women from a wide geographic area who have malignancies of the vulva, vagina, cervix, uterus, fallopian tube, ovary, and trophoblast (placenta). Our faculty is composed of nationally and internationally known subspecialists who have won numerous awards for clinical teaching. The division is committed to providing trainees with experience in our clinics and operating rooms and at our multidisciplinary treatment planning conferences.

Our division comprises an important component of the Allegheny Health Network Cancer Institute, which has established a 5-year formal collaboration with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins for research, medical education, and clinical services. We have an active clinical research program evaluating cancer screening, prevention, treatment. supportive care, and survivorship. We are affiliated with NRG, the National Cancer Institute’s clinical trial arm for multi-center research in gynecologic malignancy.

The Division of Gynecologic Oncology offers the following services:

  • Cancer risk analysis, screening, and preventive care
  • Radiation treatment planning
  • Fertility-sparing surgery
  • Minimally invasive surgery, including laparoscopy and robotic surgery
  • Radical and ultra-radical surgery for advanced disease
  • Inpatient and outpatient chemotherapy
  • Interdisciplinary tumor boards
  • Survivorship and complementary medicine seminars for patients
  • Palliative care and hospice

 

[Dept. Organization]

 

Division of Gynecology

The Division of Gynecology offers a full-range of medical and surgical services to pediatric, adolescent and adult patients.

Physicians of the division offer comprehensive evaluation and are specially trained to perform the most advanced medical and minimally invasive procedures for management of the full range of benign gynecological conditions, including:

  • Abnormal Pap smear evaluation
  • Menstrual irregularities
  • Benign ovarian cysts
  • Benign vulvar, vaginal and cervical conditions
  • Uterine anomalies
  • Endometriosis
  • Contraceptive management
  • Menopausal health/hormone replacement therapy
  • Sexually transmitted diseases

 

The division offers the following minimally invasive surgical procedures:

  • Abdominal and vaginal gynecologic surgery
  • Advanced laparoscopy
  • Robotic surgery
  • Alternatives to hysterectomy
  • Colposcopy
  • Cone biopsy for abnormal Pap smears
  • Cryotherapy
  • Hysteroscopy
  • Loop electrosurgical excision procedure (LEEP)
  • Vaginoscopy

  

[Dept. Organization]

 

Division of Maternal-Fetal Medicine

Faculty
Ronald Thomas, MD, FACOG, Chief, Division of Maternal-Fetal Medicine
Mark Caine, MD, FACOG, Medical Director, Labor and Delivery
Jennifer Celebrezze, MD
Ashi Daftary, MD
Steven Golde, MD

West Penn Hospital is a major perinatal tertiary referral center for the tri-state region. Of the more than 3,500 births annually at the hospital, about 40% involve high-risk patients, and about 600 maternal and neonatal transports are received each year.

West Penn Hospital offers patients 15 state-of-the-art Labor, Delivery, Recovery and Postpartum (LDRP) suites. These spacious rooms combine the comforts of home with the latest in technology to accommodate all of the needs of a new mother and her family. The suites are fully equipped to provide care - including critical care - for mother and infant. Should an emergency arise, the LDRPs are adjacent to three operating rooms and West Penn Hospital's 45-bed Level III Neonatal Intensive Care Unit.

The Division of Maternal-Fetal Medicine provides residents with a progressive learning experience. Rounds are held on a daily basis with faculty and attending physicians. Teaching is conducted both in didactic formats and preceptor-type fashion. All members of the obstetrics team are involved in teaching their peers. In addition, the physicians and residents of the division are actively involved in research projects.

The Division of Maternal/Fetal Medicine offers the following specialty services:

  • Antenatal and antepartum testing
  • Care for fetal abnormalities or fetal growth restriction
  • Fetal therapy, including fetal blood transfusion
  • Fetal surgery
  • Management of diabetes and hypertension in pregnancy
  • Management of pre-term labor or birth and premature rupture of membranes
  • Targeted fetal ultrasound
  • Treatment for medical complications or multiple gestations

  

[Dept. Organization]

 

Division of Reproductive Endocrinology and Infertility

West Penn Hospital is home to patient offices and Allegheny General Hospital houses the laboratories for our Jones Institute affiliate of the Jones Institute for Reproductive Medicine of Eastern Virginia Medical School.

The Jones Institute, which is dedicated to the diagnosis and treatment of infertility, using the most advanced techniques, is a leader in providing comprehensive diagnosis and treatment to couples with documented infertility (approximately 14% of American couples) through a multidisciplinary approach to treatment, with laboratory and genetic support.

Our Division of Reproductive Endocrinology and Infertility offers the following diagnostic infertility services:

  • Assessment of eggs, ovulation, cervix, uterus and Fallopian tubes
  • Assessment of male infertility
  • Evaluation for adhesions or endometriosis

 

We also offer the following state-of-the-art infertility treatments:

  • Assisted embryo hatching
  • Blastocyst transfer
  • Egg donation
  • Egg retrieval
  • Embryo cryopreservation
  • Embryo transfer
  • Intracytoplasmic sperm injection (ICSI)
  • Intrauterine insemination (IUI)
  • In vitro fertilization (IVF)
  • Laser laparoscopy
  • Microsurgery
  • Ovulation induction
  • Pre-implantation genetic diagnosis (PGD)

  

[Dept. Organization]

 

Division of Reproductive Genetics

Faculty
Christann L. Jackson, MD, FACOG, Chief, Division of Reproductive Genetics

The Division of Reproductive Genetics offers genetic counseling and comprehensive prenatal diagnostic testing. The division is staffed by a physician who is board-certified in obstetrics/gynecology and clinical genetics, as well as board-certified genetics counselors.

The division also provides genetic, environmental, and occupational history assessments. Genetic assessments are combined with targeted testing approaches to improve the efficiency and effectiveness of prenatal diagnostic testing.

The Division of Reproductive Genetics offers the following special services:

  • Amniocentesis
  • Chorionic villus sampling
  • DNA analysis
  • Fetal therapy or surgery
  • Fetal ultrasound evaluation
  • Maternal serum screening and cytogenetic studies

 

[Dept. Organization]

 

Division of Urogynecology, Female Pelvic Medicine and Reconstructive Surgery

Faculty
Allan Klapper, MD, FACOG, Network Chair, Obstetrics and Gynecology; Director of Urogynecology

The Division of Urogynecology, Female Pelvic Medicine, and Reconstructive Surgery is dedicated to providing patients suffering from urogynecologic or pelvic floor conditions with the most individualized, comprehensive care available. Various urogynecologic and pelvic floor conditions are treated through the division, including uterine and vaginal prolapse, cystocele, rectocele, enterocele, vaginal wall prolapse, female urinary incontinence, overactive bladder, pelvic and bladder pain, and urge and stress urinary incontinence. Our goal is to provide support, hope, and a better quality of life through treatments focused on the patient's individual needs and lifestyle.

Techniques offered by the Division of Urogynecology, Female Pelvic Medicine, and Reconstructive Surgery include the following:

  • Medication and conservative management
  • Collagen injections
  • Bladder instillations
  • Urodynamic testing
  • Cystoscopy
  • Reconstructive surgery, including:
  • Porcine of synthetic graft pelvic floor reconstruction
  • Laparoscopic pelvic floor reconstruction procedures
  • Suburethral slings

 

[Dept. Organization]

 


Rotations by PGY

Following are rotations for PGY1, PGY2, PGY3, and PGY4 and a sample annual Rotation Schedule.

 

PGY1 (First-Year Residents)

First-year (PGY1) resident rotations include the following:

  • Gynecology – 2 months
  • Obstetrics nights – 2 months
  • Obstetrics days – 2 month
  • Emergency Department – 1 month
  • Internal Medicine – 1 month
  • Family Medicine – 1 month
  • Triage – 1 month

 

The fundamentals of diagnosis, work-up, management, anatomy, and physiology as well as appropriate consultation are emphasized. The first-year resident actively participates in each service performing vaginal deliveries, cesarean sections, ultrasounds, and minor gynecology procedures such as D&C, hysteroscopy, biopsy, polypectomy, laparoscopy, cerclage and marsupialization.

First-year residents participate in and perform these procedures under resident and attending physician supervision from the first day of training. In addition, residents will start to see their own panel of patients in the ambulatory care center under the direction and supervision of the attendings. During off-service rotations (Internal Medicine, Emergency Department, etc.), residents function as active members of the respective team, evaluating and managing outpatient medical conditions.

[Rotations]

 

PGY2 (Second-Year Residents)

Second-year residents expand upon their knowledge and proficiency in the diagnosis and management of obstetrical and gynecological problems. At this level, there is greater participation in both the basic and more advanced gynecologic procedures including hysteroscopic myomectomy, endometrial ablation, operative laparoscopy, and minor laparotomies. In addition, there is greater participation in basic and advanced obstetrical procedures including vacuum deliveries and difficult cesarean sections.

Second-year resident rotations include the following:

  • Gynecology – 2 months
  • Obstetrics days – 2 months
  • Obstetrics nights – 2 months
  • Gynecologic Oncology – 2 months
  • Triage – 1 month
  • Reproductive Endocrinology and Infertility / Anesthesia / Outpatient Internal Medicine – 1 month

 

[Rotations]

PGY3 (Third-Year Residents)

Third-year residents have more responsibility for the management of obstetrical and gynecological patients and expand on their experiences from previous years with greater participation in more difficult cases and greater responsibility in managing and supervising the junior residents of the team.

Third-year resident rotations include the following:

  • Gynecology – 2 months
  • Forbes Regional Hospital Gynecology – 1 month
  • Allegheny General Hospital Clinic – 1 month
  • Obstetrics days – 2 months
  • Obstetrics nights – 2 months
  • Genetics / Maternal-Fetal Medicine– 1 month
  • Patient Safety/ Quality Improvement and Research – 1 month

 

Each third-year resident is required to complete a research project to be presented on Resident Research Day. Faculty members assist in the selection, design, and interpretation of research project topics. After collection of the data, results are interpreted and compared with the study hypothesis. Past projects have been presented at national meetings and published in peer reviewed journals.

 [Rotations]

PGY4 (Fourth-Year Residents)

During the fourth year, residents will continue to enhance their diagnostic and management skills while assuming responsibility as chief resident. During this year, residents will acquire the knowledge and skills necessary to function as attending obstetricians/gynecologists without direct supervision and to pass the oral and written OB/GYN Board examinations. As chief residents, fourth-year residents assume greater responsibility in supervising and teaching the junior members of the team and students. It is not uncommon for the chief resident to function as first assistant while taking the junior members through surgical procedures.

Fourth-year resident rotations include the following:

  • Gynecology – 2 months
  • Obstetrics days – 2 months
  • Oncology – 2 months
  • Breast/ Reproductive Endocrinology and Infertility – 1 month
  • Allegheny General Hospital Clinic – 1 month
  • Forbes Regional Hospital Gynecology – 1 month
  • Elective – 1 month

 

[Rotations]

Rotation Schedule

Residents rotate through most services in 2-month blocks, caring for and assuming increasing responsibility for managing the care of both teaching service and private patients as they progress through their training.

Senior residents act as the chief of each service.

A unique aspect of our training schedule is that the first 5 weeks are broken down into separate 1-week rotations to assist the residents in getting acclimated to their new roles.

Rotations include benign gynecology, obstetrics, gynecologic oncology, maternal/fetal medicine, reproductive endocrinology and infertility, and urogynecology and pelvic floor reconstruction.

In addition, residents receive primary care training via rotations in Family Practice, Emergency Medicine, outpatient Internal Medicine, Reproductive Genetics, and anesthesia.

Furthermore, an elective rotation is built into the schedule and tailored to the interests and future plans of the individual resident.

In addition to their training, residents play an important role in the education and supervision of family practice and internal medicine residents, as well as third and fourth year medical students rotating through the Department of Obstetrics and Gynecology.

At the conclusion of training, obstetric and gynecology residents are well prepared to independently manage ambulatory patients, perform basic and complex gynecologic procedures, and care for patients with both conventional and challenging obstetric and gynecologic needs.

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Sample Resident Rotations

Please see the abbreviation key below the charts.

July Rotations

Team
Orientation
Week 1 Week 2 Week 3 Week 4 Week 5
Team 1a GYN Triage OB-D OB-N US
Team 1b US GYN Triage OB-D OB-N
Team 1c OB-N US GYN Triage OB-D
Team 1d OB-D OB-N US GYN Triage
Team 1e Triage OB-D OB-N US GYN

 

August through June Rotations

PGY Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
1 GYN ED OB-N IM OB-D GYN Triage OB-N FM OB-D Team
2 OB-N GYN Triage OB-D ONC OB-N REI/IM
or REI/Anes
OB-D ONC GYN Team
3 GYN OB-D GEN OB-N PS/QI&R FH OB-D AGH GYN OB-N Team
4 OB-D GYN ONC FH AGH OB-D Breast/REI ONC Select GYN Team

 

KEY:
AGH = Allegheny General Hospital
Breast/REI = Breast Diagnostic Imaging Center or Reproductive Endocrinology and Infertility
ED = Emergency Department
FH = Forbes Hospital
FM = Outpatient Family Medicine
GEN = Reproductive Genetics
IM = Outpatient Internal Medicine
MFM = Maternal-Fetal Medicine
OB-D = OB Daytime service
OB-N = OB Night-time service
ONC = Oncology
PS/QI&R = Patient Safety/ Quality Improvement and Review
REI/Anes = Reproductive Endocrinology and Infertility or OB Anesthesia
REI/IM = Reproductive Endocrinology and Infertility or Outpatient Internal Medicine
Team = Team OB-GYN
US = OB Ultrasound

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Training Sites

Training sites for our Obstetrics and Gynecology Residency Training Program include the following:

  • Allegheny General Hospital (AGH) on Pittsburgh's North Side, which offers some of the most advanced healthcare to women, including Gynecologic Oncology, Urogynecology, Robotics Surgery, General Gynecology, Gynecologic Surgery, and outpatient resident clinical care.
  • West Penn Hospital (WPH) in Pittsburgh's East End, which has the most active Labor & Delivery unit in our network and the second in the region, with more than 3000 deliveries annually. WPH has 15 LDRP suites, an antepartum unit and separate postpartum unit. West Penn is home to the second most active Level III NICU in the region: the 45-bed unit receives more than 700 admissions annually.
  • Forbes Hospital (FH) in Monroeville, which serves the communities of eastern Allegheny and Westmoreland counties. Forbes' Women’s and Infants' Care Center offers patients high-quality, comprehensive care in a home-like setting that includes 11 beautifully designed LDRP suites focused on providing patient and family-centered care. 
  • Allegheny Valley Hospital (AVH) in Natrona Heights and its Ambulatory Care Center in New Kensington, to which our residents rotate for specialized gynecological surgery.

 

 

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Duty Hours and Night Float

Our program fully complies with Accreditation Council for Graduate Medical Education (ACGME) duty hours/week regulations.

Instruction on maintaining compliance with required duty-hour regulations is regularly reviewed with the residents and faculty.

In addition, residents receive training on how to identify and avoid fatigue during their rotations.

A night float rotation is used to ensure compliance with duty hours. Night float is scheduled with three residents on a team (PGY1 to PGY3).

 [Clinical]


Didactic Experiences

 

Didactic learning experiences include lectures, hands-on training (simulation) experiences, and conferences. There is also a suggested reading list.

Lectures
Lectures are presented by department and hospital faculty covering a comprehensive list of topics in OB/GYN as well as primary and preventive care. The lecture schedule includes 3 hours of “blocked” lectures every Friday, during which time residents are free from all clinical responsibilities. Topics include the following:

  • Normal and high-risk obstetrics
  • Oncology
  • Urogynecology and pelvic support disorders
  • Benign gynecology
  • Outpatient medicine
  • Primary and preventive care
  • Reproductive endocrinology and infertility
  • Breast disease
  • Operative gynecology
  • Genetics
  • Pathology
  • Medical ethics and jurisprudence
  • Adolescent care
  • Epidemiology and statistics

 

The schedule of lecture topics is designed to repeat every 2 years.

[Didactic]

Hands-on Training (simulation)
In addition to the didactic lectures, hands-on training courses with life-like models are available through our simulation center. Our simulation curriculum includes the following courses:

  • Hemorrhage
  • Basic maneuvers for vaginal delivery
  • Fourth degree laceration repair
  • Normal labor and delivery
  • Shoulder dystocia
  • Office gynecological procedures
  • Central venous catheter placement
  • Impaired physician

 

 [Didactic]

Conferences
The didactic experience is supplemented with interactive educational conferences:

  • Didactic Conferences
  • Director’s Conference
  • Journal Club
  • Tumor Board
  • Grand Rounds
  • Obstetrics Mortality and Morbidity (M&M) Conference
  • Gynecology M&M Conference
  • Fetal Heart Rate Monitoring Strip Conference
  • OB Multi-disciplinary Conference
  • Morning Report
  • Formal Service Rounds
  • Case Presentation
  • Practice-Based Learning and Improvement (PBLI) Presentations

 

[Didactic]

Suggested reading

Recommended texts are listed below by subject. In addition to the texts listed, residents are encouraged to utilize online resources, including literature search engines as well as online texts provided through our health sciences libraries.

CREOG and ACOG resources including Precis, and PROLOG’s can further supplement the educational requirements.

Obstetrics:

  • Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies
  • Cunningham FG, Williams JW, eds. Williams Obstetrics
  • Creasy RK, Resnik R, Iams JD, eds. Maternal Fetal Medicine Principles & Practice

 

Gynecology:

  • Novak E, Berek JS, eds. Novak’s Gynecology
  • Stenchever MA, Droegemueller W, eds. Comprehensive Gynecology
  • Te Linde RW, Rock JA, Jones HW, eds. Te Linde’s Operative Gynecology

 

Reproductive Endocrinology and Infertility:

  • Speroff L, Glass RH, Kase NG, eds. Clinical Gynecologic Endocrinology & Infertility
  • Gynecologic Oncology:
  • DiSaia PJ, Creasman WT, eds. Clinical Gynecologic Oncology

 

Urogynecology:

  • Ostergard DR, Bent JS, eds. Ostergard’s Urogynecology & Pelvic Floor Dysfunction
  • Walters MD, Karram MM, eds. Urogynecology and Reconstructive Pelvic Surgery

 

Ambulatory Medicine:

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine

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