As you progress through your training, experience is provided in the following:
Obstetrics and Gynecology
– Includes supervising laboring patients, teaching first year residents as well as medical students, gaining experience in advanced surgical skills, gynecologic pathology, colposcopy, laser and robotic surgery.
-Managing your own patients in our continuity care clinic for four years
Additional areas of focus include:
- Research (completion of a scholarly project – required)
• Breast disease
• Surgical training courses (surgical skills labs) and simulation labs
- Menopause education
- Family planning education if so desired
- NICU education
You will function as an administrative chief resident in your 4th year. Responsibilities include assigning gynecologic surgical cases to other residents and acting as surgeon on all clinic cases and some private cases which have been assigned to you.
Our residents have always had the opportunity to improve the quality of their education through feedback and suggestion – this will never change. Neither will the excellence towards education from dedicated teaching staff.
Between the two hospitals, approximately 10,000 obstetric deliveries take place annually (Butterworth 7500+, Saint Mary’s 2500+). Around 15-20% of these obstetric deliveries are traditional “clinic” patients whose care is provided by the resident under the supervision of core faculty members. The other obstetric patients are private patients of obstetricians throughout the city. The patient population includes normal obstetric patients and high-risk patients referred to sub-specialists in maternal-fetal medicine. Our resident clinic is the largest in the state, with our residents delivering approximately 1600 patients per year.
A full range of high-risk problems is seen routinely during the four years of residency. Common high-risk problems include:
- Multiple gestations
- Metabolic disorders
- Toxemia of pregnancy
- Substance abuse
Maternal Fetal Medicine – High-Risk Obstetrics
Our faculty has seven board certified sub-specialists in maternal medicine. The residents will spend one rotation in R1, R2, R3 on the high-risk obstetric service, at the Spectrum Butterworth campus. Dr. Zuidema, Dr. Romero and Dr. Colombo staff this service. Dr. Jelsema, Dr. Balaskas and Dr. Cummiskey are additional maternal fetal medicine sub-specialists at the Butterworth and Mercy Health Saint Mary’s campuses. The Regional Neonatal Intensive Care Unit is located at Spectrum Butterworth, and this generates a large volume of transferred high-risk patients from all over western Michigan. In the first year the resident will be on this service for 4 weeks as well as 6 weeks in the second and third years.
While on the perinatal service, the residents manage high-risk patients on the antepartum ward, in labor and delivery, the post partum ward, and in the intensive care unit. They also learn the techniques of ultrasonography and genetic amniocentesis. They participate in genetics counseling and assist with CVS and PUBS procedures. Mercy Health Saint Mary’s also has a level III special care nursery staffed by board certified neonatologists. Therefore, our residents are exposed to an ample volume of complicated obstetric patients.
Spectrum Health Butterworth has a High Risk Clinic. The care of the high risk patient at Mercy Health Saint Mary’s is incorporated into the continuity clinic. There is an educational and working conference that is associated with each clinic session. The perinatologists supervise these clinics, and conferences.
Throughout the four years, the residents also attend a variety of didactic teaching conferences. Obstetric M&M’s are presented at each hospital on a monthly basis. There is a multi-specialty fetal anomaly conference once a month and perinatologists give lectures every month. Weekly neonatal rounds take place at the Spectrum Butterworth campus.
Genetics is primarily learned during the rotation on Maternal Fetal Medicine perinatology in the first year. While on this rotation, residents participate in genetic counseling and diagnostic procedures. While on the Spectrum Health Butterworth Campus rotation, the residents work closely with a genetics counselor. Residents are also able to perform genetic amniocenteses and develop their skills with obstetric ultrasound.
Residents develop their skills with prenatal genetic testing and counseling in their own continuity clinics. When the patient requires consultation with a perinatologist, the resident is able to follow their patient and stay involved in the evaluation process. There is a monthly Fetal Board that is multi-disciplined and includes participants from the genetics department. Didactic lectures are also presented to the residents on genetic topics.
Although many patients come from private attendings, residents participate actively in the management and therapeutic decisions of all complicated obstetric patients. As a resident in Obstetrics/Gynecology, you will gain experience in normal obstetrics in each of the four years. The first and second years receive the greatest exposure to obstetrics. In the first year, the resident spends 6 months covering labor and delivery. The second year residents similarly cover labor and delivery for 18 weeks during the day, but they also cover labor and delivery for 12 weeks in a “night float” system. In the third year, residents spend 6 weeks on obstetrics. In the forth year, each resident spends 6 weeks as the chief of obstetrics.
Supervision is provided, in house, twenty-four hours a day by our core faculty. Starting in the first year, each resident has obstetric patients included in their own personal continuity clinic. In this clinic setting, they provide prenatal care under the supervision of upper level residents and an attending physician.
All residents are expected to attend AM & PM Report for either Obstetrics or Gynecology each day wherever assigned. At this conference, the management of labor and delivery patients or gynecology patients are reviewed with the chief resident as well as an attending and treatment plans are generated.
During the obstetrics rotation, residents learn the mechanics of spontaneous and operative delivery under the supervision of more senior residents and the attending faculty. They learn how to use forceps, the vacuum extractor, and how to perform cesarean sections. They are also responsible for post partum care and the management of complications. Vaginal delivery after cesarean section is encouraged, and residents have a sound experience in managing and delivering these patients. Residents learn the technique of external cephalic version of a breech presentation. Vaginal breech deliveries are allowed in appropriate patients, and the residents are actively involved.
Topics in normal obstetrics are also presented in didactic lectures, grand rounds, obstetrical M&M conferences, and at AM report.
Formal instruction in ultrasound techniques is obtained in several different areas. In the first year, the residents have a 4 or 2 week Ultrasound rotation working with private physicians. In the third year, the residents learn how to perform vaginal probe ultrasound from reproductive endocrinologists, Dr. Dodds, Dr. Leach, Dr. Shavell, and Dr. Young. In the second and third year, the residents spend another six weeks on maternal fetal medicine where they get additional training in ultrasound.
Each labor and delivery unit has a portable ultrasound unit provided for resident use on a continuous basis. Residents perform their own scans on laboring and prenatal patients as needed. Upper level residents and the attending faculty supervise the lower level residents, as their skills develop. Residents average approximately 150 vaginal probe ultrasounds with a much higher number of abdominal scans during their four years of training.
The experience in operative gynecology is gained at each hospital during the entire residency. It increases incrementally as the resident progresses through the four years. Even in the first year, the resident is assigned to a formal rotation on the gynecologic service, assisting in cases such as: endometrial ablations, hysteroscopy, laparoscopic tubal ligations, and dilation and curettages.
In the second year, each resident spends 6 weeks on the gynecology service. During this time, they learn to do routine pre- and post-operative care. They also learn more advanced procedures, such as operative hysteroscopies, laparoscopies, LASER ablations, and sterilizations. Also during this year, they assist on major operative procedures.
During the third year, the resident concentrates primarily on gynecology, spending 12 weeks on the gynecology service, 6 weeks on reproductive endocrinology and 6 weeks on urogynecology. During this year, the residents become involved in complicated pre- and post-operative care, performing abdominal and vaginal hysterectomies, exploratory laparotomies, operative hysteroscopies and laparoscopies, and pelvic prolapse repairs. The reproductive technologies, including GIFT, ZIFT, IVF, micro-surgical techniques and the use of LASER modalities are taught. The resident is usually the operating surgeon and the attending faculty assists them. To help our residents develop microsurgical techniques and to become more adept at delicate surgery, we utilize simulation labs.
In the last year, each chief resident receives surgical experience from the gynecologic service as well as administrative duties to assign surgical cases. They receive further surgical experience during the gynecologic oncology service and urogynecology. They assume responsibility for all aspects of operative gynecology, as well as becoming involved in teaching other residents. The level of supervision is commensurate with the level of expertise the resident has developed to that point.
Reproductive Endocrinology and Infertility
The resident’s experience is the responsibility of Dr. William Dodds, Dr. Richard Leach, Dr. Valerie Shavell, and Dr. James Young. In the third year, the resident spends six weeks on the reproductive endocrinology service. While on this rotation, the resident becomes actively involved in the evaluation and management of infertility patients. They become skilled at managing clomiphene citrate therapy, and they learn the principles of gonadotropin stimulation. They also learn about the more advanced technologies and participate in the GIFT, ZIFT, and IVF procedures.
The sub-specialists give reproductive endocrinology and infertility lectures monthly.
During the third and fourth year, residents rotate with Dr. Beth Leary and Dr. Raisa Platte. During the third year, residents rotate with Dr. Mallika Anand and Dr. Beth Leary. All of our Uro gynecologists are board certified. On both of these rotations, residents learn how to complete a full urodynamic work-up and to evaluate the structures that support the pelvic floor. They also participate in a variety of pelvic floor surgical procedures. Residents participate in the URO GYN clinic in the private offices of these physicians. Didactic lectures are also given by attending physicians specializing in the field. In addition, other members of the attending staff also perform surgical procedures for incontinence and pelvic prolapse giving the residents a very good experience doing these cases during their third and fourth years.
Our residents encounter patients with gynecologic malignancies on the general gynecologic in-patient services and the gynecologic oncology service. This exposure occurs in the second, third and fourth years. Dr. Gordon Downey, Dr. Charles Harrison, and Dr. Leigh Seamon are all board-certified gynecologic oncologists.
During these rotations, the residents participate in the care of all patients admitted onto the service. A large volume of radical surgery is done on this service and the residents have a very good experience participating in these cases. They also see patients in the private office, and follow these patients to surgery or other therapies. In this setting, the residents participate in overseeing chemotherapy. Throughout their training, the residents also attend numerous oncology and pathology conferences. At these conferences, the management of the oncology patients is discussed and the principles of radical surgery, chemotherapy, irradiation therapy, and brachytherapy are reviewed.
Our program is a 4 years in length. See below for rotation types and lengths.
Orientation – 4 weeks
Obstetrics – 14 weeks
Triage – 4 weeks
OB nights – 6 weeks
Maternal Fetal Medicine – 4 weeks
Surgical-Float – 4 weeks
NICU – 4 weeks
Ultrasound and/or Family Planning (can opt out of FP if desired) 4 Weeks
SICU – 4 weeks
EM/Breast- 2 weeks
6 weeks of gynecology
18 weeks of obstetrics
12 weeks of nightfloat
6 weeks MFM
6 weeks Oncology
PGY3 – all are 6 weeks unless otherwise indicated
Maternal Fetal Medicine
Gynecology – 12 weeks
PGY4 – all are 6 weeks unless otherwise indicated
Administrative chief – 12 weeks
Gynecology – 12 weeks
Call System/Vacation/Conference Time
You will have weekend call at both hospitals, which includes a night float person(s) who covers labor and delivery, postpartum, gynecology, and ER from 7:00 pm until 7:00 am the next morning (with a few exceptions). Weekend call is either a Friday/Sunday or a Saturday call. If you are assigned a Friday/Sunday, you will work from 5:00 pm Friday night until 7:00 am Saturday morning. On Sunday, you will work from 7:00 am until 7:00 pm at which time the night person takes over. If your call is a Saturday, you will work 7:00 am Saturday until 7:00 am Sunday. When you are on call at Mercy Health Saint Mary’s, you are responsible for labor and delivery, postpartum, gynecology, and ER calls.
Typical Four Year Experience in Obstetrics:
Spontaneous Delivery 295
Cesarean Delivery 350
Operative Deliveries 25
OB Ultrasound 65
Typical Four Year Experience in Gynecology:
Total Abdominal Hysterectomy 39
Vaginal Hysterectomy 32
Laparoscopic Hysterectomy 53
Incontinence Surgery 75
Operative Hysteroscopy 95
Trans-Vaginal Ultrasound 101
Surgery for Invasive Cancer 28
Robotic Surgery 84
Wednesday morning from 7:00 AM-Noon is protected time for educational didactic conferences. Conferences include Grand Rounds lectures, Gynecologic Morbidity and Mortality, OB Morbidity and Mortality, Primary Care topics, Urogynecology, Reproductive Endocrinology, Gynecologic Oncology, and Maternal Fetal Medicine Conferences. On the third Wednesday of every month (September –May) we hold the Visiting Professor Program where national speakers are invited. Other conferences throughout the week include morning report, Journal Club, Fetal Anomaly Board, and Gyn Tumor Conference.
A resident research project is required to graduate from the program which must be presented at some point throughout residency. Resident research is supported by Grand Rapids Medical Education Partners and the OB/Gyn Department. Financial support can be requested from the Research and Institutional Review Board. There is financial support available for resident projects. Residents are also involved in multi-institutional studies via our affiliation with Michigan State University and the VanAndel Institute.
The GRMEP Research Department provides support to residents and faculty in all areas of research and scholarly activity (e.g., quality, educational, surveys). To access more details, including templates (e.g., study protocol, poster), help request forms and other contact information, visit GRMEP Research.
We have a variety of awards which recognize both residents and faculty.
Outstanding CREOG scores
AUGS-Third Year Resident
SMFM- Third Year Resident
SLS- Fourth Year Resident
AAGL- Fourth Year Resident
Second Year Resident teaching award
Ramon Lang award-department specialty award
National CREOG Award
Kinney Award-beat faculty teacher
VanderKolk Award-resident advocate