Obstetrics and Gynecology

Tripler Army Medical Center Obstetrics and Gynecology Residency program is currently the largest OB/GYN training program in the Army. The program received continued full accreditation by the Accreditation Council for Graduate Medical Education in March 2001 with approval for training five residents per year level (PGY1 through PGY4).

Program Overview
The overall purpose of graduate education in obstetrics and gynecology at Tripler Army Medical Center is to provide a foundation for residents in the science and art of obstetrics and gynecology. Our mission is to train safe, competent obstetricians/gynecologists who are a credit to the profession, the US Army, this program, and themselves. The program is designed to provide education as a first priority and not function primarily to provide hospital service.

As an educational program in obstetrics/gynecology, our program's goals are to provide an opportunity for resident physicians to achieve the knowledge, the skills, and attitudes essential to the practice of obstetrics and gynecology. The program provides the opportunity for increasing responsibility, with appropriate supervision, formal instruction, critical evaluation and counseling for the resident.

The residency includes four years of clinically oriented graduate medical education, of which at least three years must be entirely in the specialty of obstetrics/gynecology. The patient population numbers approximately 500,000 and is remarkably diverse, including active duty personnel and their dependents, retirees and their dependents, veterans and citizens from the Pacific Basin independent island nations. Highlights of the program are outlined below.

Inpatient Management: Resident teams, each led by a senior resident provide obstetric and gynecologic care for all patients under their care. Formal teaching activities consist of patient rounds, case conferences and coverage of the appropriate basic sciences to include physiology, clinical pharmacology, metabolism, microbiology, and nutrition. Daily teaching rounds are made by the senior resident and staff teaching rounds are conducted twice weekly. In addition, inpatients are reviewed daily in morning report, and emergency admissions are formally presented and discussed. This conference is attended by all staff, residents, and medical students on the obstetric and gynecology services.

Operative Experience: The patient population provides a substantial diverse, and appropriate surgical experience after residents have mastered the basic skills. The quality of the surgical experience is emphasized without losing sight of the value to act as an assistant to master skills. A system of graded responsibility progresses from simple to more complex operations. All cases are supervised by qualified staff. Residents gain experience in management by personal evaluation of the patient's signs and symptoms, physical and laboratory findings leading to a diagnosis and decision for therapy as well as performance of the technical procedures. Surgical decision making is emphasized through the teaching of operative approaches, techniques, instrument usage, alternative management strategies, and treatment of intraoperative complications. A monthly operative log is maintained by each resident and is used for recording of the resident experience forms and case list. During the PGY3 year, two one-month rotations have been implemented into the curriculum to augment the surgical experience of the residents. A rotation was established at Blanchfield Army Community Hospital at Ft. Campbell, Kentucky in 1995 for an intensive experience in benign gynecologic surgery. A rotation in gynecologic oncology at the MD Anderson Cancer Center was initiated in 1997. The site for this external gynecologic oncology rotation was changed to the Memorial Sloan-Kettering Cancer Center in New York City at the beginning of the 2000 academic year. The duration of the interinstitutional agreements with these institutions are indefinite, but reviewed annually to reassess the continuing need for augmentation of operative experience for the residents of this program.

Outpatient Care: A wide range of ambulatory care is provided for the 7000-8000 monthly clinic visits of obstetric and gynecologic patients. The services are provided almost exclusively by residents under staff supervision. Among these services are prenatal and postpartum care, ultrasound examinations, urogynecologic evaluation, breast evaluation, reproductive endocrinology/infertility evaluation and treatment, genetic counseling, amniocentesis, colposcopy, and minor gynecological procedures.

Labor and Delivery: Both routine and high-risk obstetric patients are managed by residents under staff supervision. Patients are evaluated in the Antepartum Diagnostic Center with fetal testing, ultrasounds, doppler velocimetry, and genetic amniocentesis. Residents gain experience through management of spontaneous delivery, operative vaginal deliveries (forceps, vacuum extractor), vaginal breech deliveries, vaginal birth after cesarean delivery, and cesarean delivery. Critically ill patients are followed on labor and delivery or the Surgical Intensive Care Unit, as appropriate. While rotating in labor and delivery, experience is gained in the principles of obstetrical anesthesia, and care of the newborn is emphasized. All residents complete the Neonatal Resuscitation course twice during the 4 years.

Academic Conferences: Lectures and discussions are scheduled during block academic time on Tuesday morning. The lecture series is based on the implementation manual developed from "Educational Objectives: Core Curriculum for Residents in Obstetrics and Gynecology". The units covered are the basic sciences, professional growth and development, practice management, ambulatory health care, obstetrics, gynecology, reproductive endocrinology and oncology. Current clinical literature is regularly reviewed. Statistics and statistical concepts are reviewed during journal club presentations. Multidisciplinary conferences are scheduled every other month to include a pediatric/adolescent gynecology conference, primary care conference, and a perinatal morbidity and mortality conference. Tumor board meets monthly. All gynecologic complications and deaths are discussed monthly in the morbidity and mortality conference. Preoperative cases are presented weekly at a morning departmental conference after being presented to individual staff physicians. Residents have the opportunity to initiate topics and case conferences weekly.

Research: A well-rounded practice of obstetrics and gynecology requires experience with clinical and/or basic research. An active research environment promoted to encourage each resident to demonstrate scholarly endeavor. Each resident is required to complete and present an original research project during their OBG-2 and OBG-3 year at the annual departmental Resident Research Day. Each resident is actively encouraged to publish at least one manuscript or present a paper at a major off-island meeting.

Quality Assessment and Improvement: The concepts of QA/QI along with CQI and TQM are presented to the residents to familiarize them with the current and changing environment of medicine. The legal office is also active in presenting problems adherent to obstetrics and gynecology at least twice yearly.

Academic Year Plan: The academic year for PGY1 residents is divided into 13 four-week rotations; Categorical OB/GYN interns complete the following rotations during the PGY1 year:

• Emergency Medicine – 4 weeks
• Family Medicine – 4 weeks
• Labor and Delivery – 8 weeks
• Ambulatory OB/GYN – 8 weeks
• Gynecology – 8 weeks
• Surgical Intensive Care Unit – 4 weeks
• NICU - 4 weeks·
• Night Float - 8 weeks

The PGY2-4 years are divided into 5 rotations of approximately 10 weeks each. The rotations for each of these years are:

PGY2

• Labor and Delivery - 10 weeks
• Obstetrics – 10 weeks
• Ambulatory OB/GYN – 10 weeks
• Gynecology – 5 weeks
• Gynecologic Oncology – 5 weeks
• Night Float - 10 weeks

PGY3

• Obstetrics – 10 weeks
• Ambulatory OB/GYN – 10 weeks
• Day Float – 10 weeks
• Gynecologic Oncology – 5 weeks
• Gynecologic Oncology at Memorial Sloan-Kettering, NY – 4 weeks
• Gynecology – 5 weeks
• Gynecologic Surgery at Ft. Campbell, KY – 4 weeks

PGY4

• Obstetrics – 10 weeks
• Chief Resident – 10 weeks
• Gynecology – 10 weeks
• Night Float – 10 weeks
• Gynecologic Oncology – 10 weeks

Medical Student Information: The Department of Ob/Gyn at TAMC is actively involved in the education of third and fourth year medical students.  Every 6 weeks, approximately 4 students rotate through the department, gaining hands-on experience in a challenging academic environment, working closely with interns, residents and clinical faculty. Specific rotations include basic obstetrics and gynecology (MSIII), maternal-fetal medicine, gynecologic oncology, urogynecology and pelvic reconstructive surgery, and reproductive endocrinology/infertility.

During the rotation students are assigned a staff mentor and resident sponsor.  It is the students responsibility to present at least two formal H&P’s to the mentor, and attend the sponsors continuity clinic each week.  Fourth year students are also expected to prepare a 15-minute presentation on an Ob/Gyn related topic of their choice.   In- house call is required and averages once per week - opportunities to complete this requirement by participating with the night float team are available.

Four to six week rotations are coordinated through the Medical Education Office.    Longer and shorter rotations may be arranged individually as needed.  

For more information about student rotations, contact Mrs. Gladys Nakamura at 808-433-6992. For more information about residency training, contact the Program Coordinator Johnny Kelly at 808-433-1815.