Program, Curriculum and Rotation Schedule

A significant portion of the resident experience takes place at Rush University Medical Center. There are also rotations at Rush North Shore Hospital in Skokie and The Community Hospital in Munster, Indiana. Rush North Shore is a 250 bed community hospital located 30 minutes north of the downtown medical center. Rush North Shore is a member of the Rush System for Health. Munster Community Hospital in Munster, Indiana, a 354 bed hospital with more admissions than any single hospital in Lake County, Indiana. The Community Hospital in Munster Indiana, is a not-for-profit, non-sectarian acute care facility. Mount Sinai Hospital is a 431 bed teaching, research and tertiary-care facility. Mount Sinai provides state-of-the art health services to Chicago's West Side Community. Our 1st year residents rotate here for additional low risk obstetrical deliveries. St. Alexius Medical Center is a 331-bed community hospital located in Hoffman Estates that provides healthcare to the residents of the northwest suburbs. Our 4th year residents rotate here for additional experience in Urogynecology.

The department has a commitment to train residents in areas of general obstetrics and gynecology, the subspecialties and primary care for women. The resident curriculum has adopted and instituted all ACGME requirements and guidelines and incorporates the Council on Resident Education in Obstetrics and Gynecology (CREOG) Goals and Objectives. It includes all categories of knowledge, skill and aptitude necessary to teach residents to serve in the discipline with confidence. A new focus on individualized and computer-based learning is being introduced to complement the formerly structured and regularly scheduled teaching activities and education conferences. Grand Rounds, monthly Journal Clubs, interactive didactic M&M sessions, and visiting faculty programs round out the educational experiences.

Clinical Rotations
In addition to clinical rotations, the residency program offers a range of opportunities in ambulatory medicine. Residents are also required to complete a research project as part of the program.

• Normal Obstetrics
  The exposure to normal obstetrics is concentrated in the 1st and 2nd years of the residency program. These experiences are intended to prepare the residents with the skills, information base, comfort and confidence needed for the evaluation and management of more challenging obstetric patients.
  
  The 1st year residents clinical activities include performing procedures such as vaginal deliveries, perineal repairs, postpartum tubal ligations and uncomplicated cesarean sections. The 2nd year residents assess and triage patients presenting to the labor and delivery unit with acute problems. They are involved in the more complex operative deliveries and high-risk labor and delivery management. The 3rd and 4th year residents provide educational supervision of the residents on the obstetrical team.
  
  The obstetrics and gynecology faculty provides the ultimate supervisory role as well as lead the educational experiences in obstetrics. Formal group education occurs in the clinical setting as well as in didactic sessions. There are daily a.m. and p.m. rounds performed in the labor and delivery unit. These are teaching as well as clinical care rounds. The rounds are supervised by the faculty and conducted by the senior obstetric resident. There are also formal obstetric resident M&M case presentations once every 6 to 8 weeks.
  
  
• High Risk Obstetrics
  Each resident rotates through the maternal-fetal service for two months during their 3rd year. Second year residents also have ambulatory experience in this high-risk clinic. The residents participating in these experiences take care of ambulatory patients with medical, obstetrical and fetal complications, such as diabetes, hypertension, pre-eclampsia, autoimmune diseases, cardiac disease, renal diseases, transplant recipients and fetal anomalies.
  
  Rush is the perinatal center for the Rush/Illinois Masonic Perinatal Network. As such, our Maternal-Fetal Medicine program draws from a network of 17 hospitals with a delivery base of over 32,500 deliveries. It is currently the largest networks in the state of Illinois. Our Network was involved in the transfer of 236 high risks mother during 2007. This allows us to provide our residents with a wide variety of cases and a much larger proportion of high risk training.
  
  The 3rd year resident on the maternal-fetal-medicine service also participates in the monthly Fetal-Neonatal Meeting where pregnancies complicated by fetal anomalies or congenital conditions (arrhythmias. Isoimmunization) are discussed.
  
  
• Gynecology
  All the operative gynecology cases performed at Rush University Medical Center, Rush North Shore Medical Center and The Community Hospital in Munster, Indiana are available for resident education.
  
  The residents are required to be knowledgeable about the patients' diagnosis, treatment options, preoperative work-up, planned surgical procedures and potential intra-and post-operative complications. In addition to providing supervision, the attending engage in informative discussion and in intra-operative surgical training. In addition to daily rounds with the attending, residents meet with an attending several times a week for formal didactics. These sessions include students as well as residents on the service. Topics revolve around the educational objectives of the rotation for the various residents.
  
  Assignments of cases vary based on experience. During the 1st and 2nd year, residents primarily are involved with D&C's, diagnostic hysteroscopy, laparoscopy, tubal ligation, and simple open cases. During the 2nd year most residents are also expected to perform some abdominal hysterectomies. Residents in the 3rd and 4th year participate in major abdominal cases, vaginal hysterectomies and operative laparoscopies.
  
  The 1st and 2nd year residents spend time undergoing instructions on the use of instruments, knot-tying and surgical techniques. The 3rd and 4th year residents gain skills in the performance of more difficult procedures with instruction using simulated models. Our residents are also involved in the Clinical Anatomy and Surgical Skills Training (CASST) program. This is a unique nationally recognized multi-institutional surgical training program that allows us to train our residents to the various obstetric and gynecologic procedures. While surgical procedures are reviewed with the aid of surgical simulation anatomy is reinforced using a combination of didactics and cadavers.
  
  
• Gynecologic Malignancies
  The division of Gynecological Oncology has become one of the largest referral base in the State of Illinois and has precipitously increased the gynecologic oncology volume. There are approximately 6,200 patients seen in the clinic with an average of approximately 7 to 15 major and 10 minors per week.
  
  The Junior residents manage in-patient problems, attend out-patient sessions and are involved in simpler gynecological cancer surgeries under direct supervision of both the senior residents and faculty. In addition, the resident becomes familiar with the cognitive aspects of gynecological cancer care, and the practical aspects of diagnosis, testing, and peri-operative care. Senior residents coordinate in-patient care, participate in the decision making process and perform as co-surgeon or first assistant in the more radical gynecological cancer surgeries.
  
  Other formal teaching activities include: daily attending rounds with a senior attending, weekly patient management conferences, weekly clinical-pathological didactic conferences and faculty lectures. There are also formal oncology resident M&M case presentations once every 6 to 8 weeks.
  
  We have a comprehensive weekly didactic (Tumor Board) conducted by the gynecologic oncology and pathology residents. Faculty from gynecologic oncology, medical oncology, radiation therapy, gynecology and gynecologic pathology attend this conference.
  
  
• Infertility and Endocrinopathies
  The Section of Reproductive Endocrinology and Infertility coordinates educational and clinical activities in this sub-specialty area. The section provides a comprehensive and scientific approach to the evaluation and treatment of women with gynecologic endocrine problems and disorders of development and infertility. When appropriate, assisted reproductive technologies such as in vitro fertilization (IVF), gamete intra-fallopian transfer (GIFT) or others are offered. The resident is expected to attain a thorough appreciation of the scientific basis for these procedures and for patient selection. Patients seen in the infertility/endocrinology center undergo a complete diagnostic. The work-up consists of standardized forms, ovulation timing sheets, male and female fertility questionnaires. Pituitary, adrenal and ovarian dynamic testing is performed as needed. Semen processing and therapeutic intrauterine inseminations are performed in the office.
  
  Teaching activities of the section consist of regularly scheduled case conferences, IVF conference, endocrine lectures, research seminars, didactic sessions, as well as "bedside" teaching in the center, operating rooms and on surgical floors. Residents participate in all clinical, surgical and didactic activities of the section. During the rotation, the resident develops a basic knowledge of reproductive disorders and their management. Moreover, they also gain an understanding of the principles of oocyte retrieval and embryo transfer. The resident develops the technical skills for transvaginal ultrasound examinations, hysterosalpingography, laparoscopy, hysteroscopy, sonohysterography and fertility surgery. Management of patients on the service, coordination of didactic sessions, and involvement in weekly conferences are done under the direct supervision of the attending reproductive endocrinologists.
  
  
• Urinary Incontinence and Pelvic Floor Dysfunction
  Didactic teaching is provided to all residents during the regularly scheduled resident lecture series and grand rounds series. Specific clinical contact is provided to the residents who are on the Urogynecology. These rotations occur during the second and fourth year of residency. This rotation provides experience in ambulatory assessment and care, as well as surgical management of urogynecologic problems. Specific didactic lectures are reviewed during this rotation utilizing the learning objectives supplied by the CREOG Learning Objectives. The resident participates in the initial intake of new urogynecology patients and presents the history of new urogynecology patients to the attending for discussion prior to the physical examination. Patients-specific teaching allows the resident to demonstrate the increases in knowledge which have been attained as a result of self-study, didactic or clinical presentations. Residents participate in discussions regarding initial treatment or need for further diagnostic testing. Exposure to common office procedures include fitting/managing pessaries and incontinence rings, single channel cystometrograms, obtaining post-void residual measurements, instructing patients in self-catherterization. Advanced residents may also participate in complex multichannel urodynamic and neurophysiologic assessments. Following the rotation, the resident is expected to be familiar with a variety of modalities for management of urinary and/or fecal incontinence, including behavioral modification, bladder drill, electrical stimulation, pelvic floor exercises, and medications.
  
  Residents are expected to participate in the entire surgical experience of the Urogynecology Section. The residents are expected to understand the anatomy and steps of common reconstructive procedures. The resident observes reconstructive surgery, and participates as the primary assistant whenever feasible. As surgical skills advance, the resident is taught colpourethropexy and common vaginal reconstructive procedures. Specific training is given for lower urinary tract safety during urogynecologic surgery. This includes cystoscopy and ureteral recognition with dissection. The resident follows each patient post-operatively and is expected to manage any post-operative complications including urinary retention and suprapubic catheter use. Ample opportunities exist for participation in ongoing clinical and basic science research within the section.
  
  
• Ultrasonography
  Experience in ultrasonography is obtained during all obstetrics and gynecology rotations. Residents obtain ongoing experience during their obstetrical rotation under the supervision of the maternal fetal medicine specialists. The 1st and 3rd year residents rotate through the office of Ultrasound in Obstetrics and Gynecology. During the rotation they are trained to perform routine and targeted obstetrical ultrasounds, gynecological ultrasounds, color and pulse wave dopplers, saline sonohysterograms and amniocentesis. Residents are involved in the counseling of patients with fetal structural and chromosomal abnormalities. These counseling sessions are multidisciplinary and includes pediatric surgeons, pediatric subspecialists, NICU personnel and social workers.
  
  Gynecologic ultrasound experience is incorporated into the reproductive endocrinology and infertility rotation and ambulatory continuity clinics. The residents perform abdominal and transvaginal ultrasounds which also include sonohysterograms. Supervision is provided primarily by reproductive endocrinology and infertility specialists.
  
  
• Ambulatory Medicine and Continuity Clinic
  The program offers many opportunities in ambulatory medicine, including rotations in the Adolescent Family Center, the subspecialty faculty practices, private practice offices. Each week, residents spend a half a day following their own panel of patients under faculty supervision.
  
  Emphasis is placed on caring for patients with common gynecological problems, normal obstetrics and preventive medicine and primary care. In addition, residents have the opportunity to learn all aspects of running a private practice, including managing staff, coordinating patient scheduling, billing and collections and interacting as appropriate with all other agencies affecting their patient's care within the Medical Center.
  
  
• Research
  All residents are required to complete a research project. This is intended to help residents develop an appreciation for the importance of research. The project culminates in the formal presentation of a paper at the end of the fourth year. Resident papers are often clinical, although opportunities exist for participation in basic science research.