OBGYN Residency - Clinical Training

This first-year rotation offers broad exposure to both surgical and clinical care. Interns gain hands-on experience in the OR with gynecologic procedures and develop foundational skills in hysteroscopy and laparoscopy. They care for patients on the general gynecology and urogynecology services, consult on cases in other inpatient units and the emergency department, and take part in introductory ambulatory experiences in urogynecology and general gynecology. Interns are expected to build core clinical skills, including gathering patient history, performing pelvic exams, identifying problems, selecting diagnostic tests, making accurate diagnoses, developing treatment plans and arranging follow-up care.

During the first-year labor and delivery rotation, interns play a key role on the day coverage team. They gain hands-on experience with essential obstetrical skills, including managing normal deliveries and repairs, learning primary cesarean techniques, and overseeing second-trimester elective inductions. As the intern year progresses, PGY-1 residents begin admitting and managing more complex antepartum cases and performing repeat cesarean deliveries to prepare for the responsibilities of PGY-2.

The first-year night float rotation provides a focused introduction to obstetrics and labor and delivery management, including recognizing and handling common obstetrical issues. Interns gain hands-on experience with normal deliveries and repairs, learn primary cesarean techniques, and manage second-trimester elective inductions. They also serve as overnight consultants in the emergency room, gaining experience diagnosing and treating acute gynecologic problems.

The first-year rotation in gynecologic oncology focuses on two main goals. First, interns develop a foundational understanding of gynecologic oncology principles and practices. Second, they learn and apply postoperative care for both routine and complex patients. Interns manage the inpatient gynecologic oncology service and assist in evaluating clinic patients under direct supervision. In the operating room, they gain initial experience with opening and closing the abdomen during major gynecologic surgeries.

During this rotation, PGY-1 residents are introduced to outpatient obstetrics and gynecology through direct faculty supervision. A typical week includes outpatient obstetrics and gynecology clinics, as well as time at the Perinatal Diagnostic Center (PDC), where interns gain exposure to a variety of perinatal ultrasounds and work closely with maternal-fetal medicine attendings. Residents also participate in genetics and pediatric gynecology clinics during this block.

During this five-week rotation, the intern joins the MICU team alongside surgical residents and attendings at Tufts Medical Center. The focus is on the differential diagnosis, evaluation and treatment of serious medical co-morbidities. This rotation provides a foundation for managing complex medical conditions in pregnancy, as well as common postoperative complications and gynecologic issues in patients with significant medical illnesses.

The Emergency Medicine rotation is a four-week experience in the Tufts Medical Center Emergency Department. The focus is on evaluating and managing urgent medical and primary care issues. During this rotation, interns develop skills in quickly obtaining focused histories and performing targeted physical exams to assess emergency cases. They also learn to coordinate consultations and arrange appropriate follow-up care.

This rotation divides the resident’s time among three specialties: reproductive endocrinology and infertility, pediatric and adolescent gynecology and family planning.

• Reproductive endocrinology and infertility clinic: The resident will be exposed to both the diagnosis and management of infertility and, through this process, will develop a proficiency in the performance and interpretation of transvaginal ultrasonography. Additionally, the resident will be exposed to a large variety of the hormonal milieu of the female patient, with expectations to learn basic physiologic principles.
• Pediatric and adolescent gynecology clinic: The resident will become comfortable with the pediatric gynecologic examination. The resident will learn how to perform an adolescent’s first gynecology exam and become aware of the stages of adolescent development and pertinent adolescent issues. At a bi-monthly conference, the resident will discuss different diagnoses and treatment regimens in patients with menstrual irregularities.
• Family planning: service will focus on the counseling and management of both first and second trimester pregnancy terminations. Additionally, the resident will be exposed to contraceptive counseling as well as epidemiologic discussions of women’s health issues. The resident is encouraged to voice their own thoughts and preferences for their desired extent of participation and has the opportunity to opt out of any procedures. There may be an opportunity to work at Planned Parenthood of Boston every Friday under the supervision of the family planning staff.

The second-year resident begins managing more complex obstetric cases, including overseeing the maternal-fetal medicine postpartum service. They perform most repeat and more challenging cesarean deliveries and other procedures on labor and delivery. This resident also assists with admitting high-risk obstetric transfers from other hospitals and helps manage the antepartum service under the supervision of the PGY-3 and PGY-4 residents on service. The PGY-2 continues to advance ultrasound skills, focusing on biometry and cervical length measurements.

Two residents, one third-year and one second-year, assist in managing the obstetrics and gynecology services at Southern New Hampshire Medical Center. The PGY-2 cares for obstetric and gynecology patients on labor and delivery and in the operating room. This includes participation in day surgery, gynecologic oncology, and benign gynecologic cases. The PGY-2 develops proficiency in minor gynecologic and obstetric procedures, such as vaginal and operative deliveries, cesarean sections, and management of labor complications. They also help manage the labor and delivery unit, as well as the antepartum and postpartum services. During this rotation, the PGY-2 collaborates with a family medicine resident who also covers labor and delivery. Additionally, the PGY-2 participates in an outpatient continuity clinic, gaining experience in office-based surgical procedures, transvaginal ultrasound, and general outpatient OBGYN care.

The second-year rotation builds on the intern year, offering increased autonomy. Residents care for patients on the labor floor, gaining experience with repeat cesarean sections and managing high-risk obstetrical conditions. They also serve as overnight consultants in the emergency room, diagnosing and managing acute gynecologic problems.

The third-year elective is a flexible 10-week block designed to meet each resident’s individual interests and goals. Residents work with the Program Director ahead of time to create a personalized plan. Past electives have included developing research projects, participating in international medical programs, or pursuing additional training in areas related to potential fellowship interests.

During this third-year rotation, the resident takes primary responsibility for managing antepartum patients on both the generalist and Maternal-Fetal Medicine (MFM) attending services. The focus is on caring for patients with high-risk obstetrical complications and those with complex medical conditions during pregnancy. Resident experience includes the antepartum service, labor and delivery, the Center for Perinatal Diagnosis (ultrasound clinic) and the MFM outpatient clinic.

During this third-year rotation, the resident works alongside three residents from Boston University Medical Center and a MIGS fellow at Lahey Hospital and Medical Center. Together, they manage general gynecology and gynecologic oncology services. Lahey is a high-volume surgical center offering excellent opportunities to develop skills in both open gynecologic surgery and advanced minimally invasive procedures.

Two residents, one third-year and one second-year, support the obstetrics and gynecology services at Southern New Hampshire Medical Center. The third-year resident serves as the chief resident and oversees the junior residents. Their clinical focus is mainly gynecology, including coverage of both the gynecologic oncology service and a high-volume generalist practice. They also manage complex patients on labor and delivery, as well as inpatient antepartum and postpartum units. This rotation includes exposure to outpatient surgery, transvaginal ultrasound, and participation in the continuity clinic.

While on day float, the chief manages labor and delivery and stays informed about antepartum and postpartum patient services. They work closely with the second-year day resident and the third-year MFM resident as part of the full obstetrical team. Additionally, the family planning intern assists with labor and delivery room coverage, and the chief is responsible for their supervision and education. The night float chief has similar duties but also covers inpatient gynecology and oncology patients, as well as any consults that come in overnight.

This chief resident manages both the generalist and urogynecology services. Their primary role is to assist in all major gynecologic surgeries and oversee the inpatient gynecology unit alongside the intern. The variety of surgeries provides excellent exposure to advanced laparoscopic and robotic techniques. Additionally, the chief supervises the intern in ambulatory responsibilities and consults.

While chief of the gynecologic oncology service, the resident works closely with their intern and the attending staff. The chief is primarily responsible for coverage of all procedures and managing the inpatient service. When time allows, they also assist the attending staff in the ambulatory clinic. Additionally, the chief provides one-on-one training to the oncology intern and supervises their progress in mastering the Fundamentals of Laparoscopic Skills (FLS) testing.

This chief resident serves both in a coverage role and an expanded ambulatory care position by attending various clinics. The clinics chief provides coverage for the gynecology and obstetric chiefs when other duties, such as continuity clinics or vacation, prevent them from managing the service. Additionally, they attend specialty clinics including early pregnancy, colposcopy and breast clinics.

The continuity clinic experience takes place during the last three years of residency. It consists of a half-day per week ambulatory clinic focused on antepartum and postpartum care, ambulatory gynecology and well-woman primary care. Residents concentrate on outpatient history taking, physical exams, office procedures, health screenings, immunizations and patient education. Each resident is assigned a clinic location at the end of their intern year and continues at that site throughout their training. Clinic locations include Tufts Medical Center, Neponset Health Center, Cambridge Hospital and Metrowest Medical Center.