The educational objectives for the Tufts MC OB/GYN residency program are broken down by year and rotation. They are mandated by the Residency Review Committee for Obstetrics and Gynecology, and designed to give guidelines for learning expectations for each rotation. These guidelines are to be used in tandem with the CREOG Educational Objectives, which contain the required objectives for completion by all residents of an accredited program. Achieving the educational objectives occurs through a combination of clinical experiences, scholastic conferences, the didactic program, reading and simulation.
This first year rotation is diverse and provides the intern excellent training both in the operating room as well as in inpatient and ambulatory clinical care. In the OR, the intern will gain initial exposure to gynecologic procedures and learn the basic skills of hysteroscopy and laparoscopy. They will manage patients admitted to the general gynecology and urogynecology services, as well as provide consultation to other inpatient units and the emergency room. A final element of this rotation is to participate in an introductory ambulatory experience both in urogynecology and in a general gynecology clinic. During this time, the intern is expected to become proficient in obtaining a complete and pertinent history, performing a pelvic exam, prioritizing patient problems, determining the appropriate diagnostic studies, arriving at the correct diagnosis, deciding on the appropriate treatment, and arranging follow-ups.
Labor and Delivery Day Float
While on the first-year rotation on labor and delivery, the interns serves as an integral part of the day coverage team. Interns will be exposed to fundamental obstetrical skills, particularly extensive experience with normal delivery and repairs, introduction to primary cesarean technique, and management of second trimester elective inductions. As the PGY-1 progress through the intern year, they will start to admit and manage more complex antepartum cases and perform repeat cesareans in preparation for the PGY-2 year.
The first-year rotation on the night float service is a concentrated introduction to obstetrics and the general running of labor and delivery including the recognition and management of common obstetrical problems. Interns will be exposed to fundamental obstetrical skills, particularly extensive experience with normal delivery and repairs, introduction to primary cesarean technique, and management of second trimester elective inductions. They will also gain experience in the diagnosis and management of acute gynecologic problems as overnight consultants in the emergency room.
The first-year rotation in Gynecologic Oncology has two main educational objectives. The first is to acquire a basic understanding of the principles and practice of gynecologic oncology. The second is to understand the principles of postoperative care and to apply those principles both to routine and complicated postoperative patients. The duties of the intern include management of the inpatient gynecologic oncology service and participation in evaluating patients in the gynecologic oncology clinic under the direct supervision of the attending staff. While in the operating room, the intern will gain initial experience opening and closing the abdomen for major gynecologic procedures.
Surgical Intensive Care Unit
For this five-week rotation, the intern joins the MICU service alongside the surgical residents and attendings of Tufts Medical Center. The main focus of this rotation is the differential diagnosis, evaluation and treatment and serious medical co-morbidities. This rotation should give the resident a foundation for the management of complicated medical conditions in pregnancy as well as the management of common post-operative complications and gynecologic problems in patients with serious medical conditions.
The Emergency Medicine rotation is a four-week experience in the Tufts Medical Center Emergency Department. The focus of this rotation is the evaluation and management of emergent medical and primary care problems. During the rotation, the intern should become accustomed to obtaining a focused history rapidly and doing a targeted physical exam to evaluate emergency problems. Additionally, they should become familiar with obtaining appropriate consultation on patients and in the coordination of follow-up care.
CLINICS: Reproductive Endocrinology & Infertility/Pediatric & Adolescent Gynecology/ Family Planning
This rotation divides the resident’s obligations between several clinical specialties: Reproductive Endocrinology & Infertility, Pediatric & Adolescent Gynecology, and Family Planning.
REI 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.
PAG clinic: the resident will become comfortable in 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.
Labor and Delivery Day Float
The second year resident will begin to manage more complex obstetric cases, including managing the maternal fetal medicine postpartum service. Additionally, the PGY-2 will perform the majority of the repeat and more challenging cesareans and other procedures that occur on labor and delivery. This resident will also help to admit high risk obstetric transfers from other hospitals and, at time, help to manage the antepartum service with oversight from the PGY-3 and PGY-4 on service. The PGY-2 will continue to develop their ultrasound skills, specifically biometry and cervical lengths.
Southern New Hampshire Medical Center
Two residents, one third year and one second year, aid in the management of the obstetrics and gynecology services at Southern New Hampshire’s Medical Center.
The PGY-2 at SNHMC will care for obstetric and gynecology patients on labor and deliver and in the operating room. This will include participating in day surgery, gynecologic oncology, and benign gynecologic cases. The PGY 2 will become proficient in minor gynecologic procedures and obstetric procedures, including vaginal and operative delivery, cesarean delivery, and management of complications of labor. The PGY 2 will assist in managing the labor and delivery unit, as well as the antepartum and postpartum services. You will also have the opportunity to work with a family medicine resident during this rotation who will also be covering labor and delivery. The PGY2 will participate in a outpatient continuity clinic where they will learn how to perform office based surgical procedures and transvaginal ultrasound as well as general outpatient obgyn care.
Metrowest Medical Center
Two residents, one third year and one second year, aid in the management of the obstetrics and gynecology services at Metrowest Medical Center. While at Metrowest, the residents have the opportunity to work with a preliminary year Ob-Gyn resident who manages Labor and Delivery and shares in the call schedule. The second year resident’s primary role is to assist in all gynecologic minor procedures and all major procedures not covered by the chief resident. With participation in surgery, the resident’s educational goals include the development of an understanding, not simply in the surgical anatomy and medical therapy, but also in the pathophysiologic principles underlying that therapy, the evidence upon which that therapy is based, and the consequent side effects. While on call, the responsibilities of the resident extend to coverage of labor and delivery, as well as the postpartum services. Additionally, the residents will cover a free care women’s health clinic organized by the medical center.
The third-year elective does not have specific educational objectives but is meant to be a 10-week block that can be tailored to the individual needs and interests of each resident. The resident will discuss a plan with the Program Director well in advance of the beginning of the rotation. In the past, this rotation has been used for the development of research projects, as a chance to participate in international medical programs, or as a time to focus on additional training in areas of potential fellowship interests.
For this third year rotation, the resident will be in charge of managing the antepartum patients for both the generalist and the Maternal-Fetal Medicine attending services. The focus of the rotation is the management of patients with high-risk obstetrical complications as well as pregnancies of patients with complicated medical conditions. Resident experience includes the following areas of patient care: antepartum service, labor and delivery, Center for Perinatal Diagnosis (ultrasound clinic), and MFM outpatient clinic.
Lahey Hospital and Medical Center
For this third year rotation, the resident will team with three residents from Boston University Medical Center as well as a MIGS fellow at Lahey in the management of the general gynecology and gynecologic oncology services. Lahey Hospital and Medical Center is a high volume surgical center and an excellent rotation for enhancing skills in both open gynecologic surgery as well as advanced minimally invasive procedures.
Southern New Hampshire Medical Center
Two residents, one third year and one second year, aid in the management of the obstetrics and gynecology services at Southern New Hampshire Medical Center. The third year resident functions as the chief resident while at SNHMC with responsibilities extending to the general supervision of the junior residents. The clinical experience for the chief resident is predominantly gynecologic with coverage of both the gynecologic oncology service as well as the high-volume generalist practice. You will also be covering complex patients on labor and delivery, inpatient antepartum and postpartum patients. During this block you will also have exposure to outpatient surgery in the clinics and transvaginal ultrasound as well as participation in the continuity clinic.
Metrowest Medical Center
Two residents, one third year and one second year, aid in the management of the obstetrics and gynecology services at Metrowest Medical Center. While at Metrowest, the residents have the opportunity to work with a preliminary year Ob-Gyn resident who manages Labor and Delivery and shares in the call schedule. The third year resident functions as the chief resident while at Metrowest with responsibilities extending to the general supervision of the junior residents and Tufts Medical students. The third year resident’s primary role is to assist in all gynecologic major procedures including a large variety of minimally invasive surgeries. While on call, the responsibilities of the resident extend to coverage of labor and delivery, as well as the postpartum services. Additionally, the residents will cover a free care women’s health clinic organized by the medical center on Tuesday evenings and Thursday afternoons.
During their final year at Tufts Medical Center, the chief resident is responsible for the management of each of the main divisions of care including: labor and delivery (day float and night float), benign gynecology (urogynecology and general), gynecologic oncology, and clinical care. On all services the chief resident is responsible not only for overseeing the management of patient care but also in the general supervision and education of the junior residents and Tufts Medical students.
Day and Night Float Labor and Delivery
While on day float the chief will manage labor and delivery as well as be aware of the antepartum and postpartum patient services. They work closely with the second year day resident as well as the third year MFM resident to compromise the full obstetrical team. Additionally, the family planning intern helps to cover LDR and the chief is responsible for their supervision and education. The night float chief functions in much the same way, however they also cover the inpatient gynecology and oncology patients as well as cover any consults received overnight.
This chief works to manage both the generalist as well as the urogynecology service. Their primary role on the service is to assist in all major gynecologic surgeries and run the inpatient gynecology unit with the intern. The breadth of gynecologic surgeries is diverse with excellent exposure to both advanced laparoscopic and robotic skills. Additionally, the chief will supervise the intern in their ambulatory responsibilities as well as with any consults.
While chief of the gynecologic oncology services, the resident will work closely with their intern as well as the attending staff. The chief is primarily responsible for coverage of all procedures as well as managing the inpatient service. When other responsibilities permit, the resident is involved in working with the attending staff in their ambulatory clinic. Finally, the chief resident is responsible for one-on-one training of the oncology intern and supervising them in the mastery of their FLS (Fundamentals of Laparoscopic Skills) testing.
This chief resident functions both in a coverage role as well as in an expanded ambulatory care position attending various clinics. The clinics chief will provide coverage for the gynecology and obstetric chiefs when other responsibilities such as their continuity clinic or vacation time interrupt managing the service. Additionally, they attend a variety of specialty clinics including early pregnancy clinic, colposcopy clinic, and breast clinic.
PGY-2 through PGY-4
The continuity clinic experience occurs in the last three years of the residency. It is a half-day per week ambulatory experience that focuses on antepartum and postpartum care, ambulatory gynecology, and well woman primary care. The focus of the continuity clinic is ambulatory history taking, the outpatient physical exam and office procedures, health screening and immunizations, and patient education. The resident is assigned a clinic location at the end of their intern year and will continue to attend that clinic throughout the three years. The clinic locations include: Tufts Medical Center, Neponset Health Center, Cambridge Hospital, and Metrowest Medical Center.