TTUHSC School of Medicine at Amarillo
HSC Home Amarillo CampusSOM HomeObstetrics & Gynecology

Obstetrics & Gynecology

Residency Information

General Information

4 YEARS FULL ACCREDITATION

We are proud to annouce we recieved 4 years full accreditation from the ACGM on our RRC inspection March 2005.

The Department of Obstetrics and Gynecology at Texas Tech University Health Sciences Center at Amarillo offers a four year obstetric and gynecology residency program, which is fully accredited by the Accreditation Council of Graduate Medical Education of the American Medical Association, and is approved for three residents at each level. In the year 2000, the department celebrated its twentieth anniversary of residency training.

The residency program is designed to offer experience in the diverse areas of obstetrics and gynecology to prepare residents for a career in either private practice, fellowship training in subspecialties, or in academic medicine. The clinical experience is gained by exposure to approximately 2000 deliveries per year, an average of 750 major gynecologic surgical procedures per year, and an outpatient service of greater than 24,000 patient visits per year. The department is complimented by experienced subspecialty faculty working within our two primary teaching hospitals. Because of the geography of the area, the department serves as a tertiary referral center for maternal fetal medicine, gynecologic oncology, and reproductive endocrinology and infertility.

In 2000, Texas Tech University Health Sciences Center established the Women's Health Research Institute of Amarillo that is a multi-campus, multi-discipline effort in women's health. This institute is based primarily upon the research efforts of our department through our research laboratory, clinical trials division, faculty research and resident research. Our department collaborates with over twenty other universities and research organizations around the country. Residents are expected to actively participate in research and regularly present papers at regional and national meetings and publish in peer review journals.

Texas Tech University Health Sciences Center at Amarillo is located within the Harrington Regional Medical Center. This unique four hundred-acre campus includes our primary teaching hospitals, Northwest Texas Healthcare System, Baptist St. Anthony's Healthcare System, and the Harrington Cancer Center. These facilities are connected by tunnel to the medical school building. The Veterans' Hospital is located immediately adjacent to the medical center. Our high risk obstetrical service at Northwest Texas Healthcare System is serviced by helicopter transport units and a thirty bed neonatal intensive care unit.

The department functions in multiple outpatient facilities including the University Physicians of Texas Tech at Amarillo, the University Women's Health Center, Women's and Children's Health Center, the Harrington Cancer Center, Planned Parenthood of Amarillo, and the Veterans' Hospital outpatient facilities. Services available include obstetrical and gynecologic ultrasound, bone densitometry, urodynamic testing, incontinence biofeedback, and the full range of general and subspecialty care.

The Don and Sybil Harrington Medical Library located at the Texas Tech University Health Sciences Center Building houses 35,000 volumes of medical literature, as well as med-line services. The departmental library maintains selected periodicals, standard monographs, textbooks, and a wide array of computerized learning materials.

Our department is growing and dynamic. A very specific strategic planning process is in place for all aspects of the department. The facilities, personnel, patient volume, research effort, and institutional vision offer a maximal experience in patient care, education, and research.

Mission Statement

The mission of the Texas Tech University Health Sciences Center is to improve the health of people by providing educational opportunities for students and health care professionals, advancing knowledge through scholarship and research, and providing patient care and service.

Vision

Texas Tech University Health Sciences Center will be recognized nationally as a top-ranked health sciences university.

Values

We value:

Integrity, approach our work with competence, character, and perseverance

Trust, providing respect, empowerment, open communications and loyalty within the work environment

Personal responsibility, to care for all stakeholders and honor commitments as representatives of Texas Tech University Health Sciences Center

Collaboration , working as a team to share resources, risk, responsibility, and recognition

Stewardship , delegating responsibilities and being accountable as individuals and to the community

Educational Objectives

The residency training program utilizes the educational objectives as recommended by the Council on Resident Education in Obstetrics and Gynecology. These objectives are specifically outlined in the publication CORE CURRICULUM IN OBSTETRICS AND GYNECOLOGY, Sixth Edition that is given to all residents at the beginning of training. Residents are reminded and encourage to progressively master the objectives that are specific to their current work and are expected to have met all of the educational objectives upon completion of the program.

The department has identified the following general educational objectives:

  1. To educate resident physicians in the health care of women
  2. To develop a lifelong commitment to continuing education, as well as deep sense of caring for patients
  3. To familiarize resident physicians with research methods, literature interpretation and inspire acquisition of new knowledge through research
  4. To provide a wide range of inpatient and outpatient experiences and educational objectives as is suggested in the CORE CURRICULUM IN OBSTETRICS AND GYNECOLOGY
  5. To provide, with direct supervision of faculty, an environment of progressive clinical responsibility so that at the program's conclusion, a resident will be qualified by virtue of technical skills, didactic knowledge, and clinical judgement to be a consultant in our specialty
  6. To motivate residents to acquire the technical skills and knowledge base to become certified by the American Board of Obstetrics and Gynecology
  7. To prepare residents to proceed into subspecialty fellowships, academic medicine, or the private practice of obstetrics and gynecology

Program Director

The Program Director is appointed by the Dean of the School of Medicine upon the recommendation of the Regional Dean and the Faculty Appointments Committee. The Program Director is also the Regional Chair. The Program Director's tenure is indefinite with an annual reappointment. The Program Director has the authority to oversee and organize the activities of the educational program including resident appointments and assignments; supervision, direction, and administration of the educational activities; and evaluation of the residents, faculty, and residency program.

Faculty Appointment

The Regional Chair is appointed by the Dean of the School of Medicine upon recommendation by the Regional Dean, with approval of the President of the Health Sciences Center, the Chancellor, and the Board of Regents. The term of appointment is indefinite, with an annual contract renewal. The full time and part time faculty are appointed similarly upon the recommendation of the Regional Chair. Their appointments are also indefinite with an annual contract renewal.

Volunteer appointments are for one year and are appointed by the Regional Chair.

All full time, part time, and volunteer faculty appointments must be approved by the Faculty Appointment Committee. This committee is composed of at least one faculty member from each academic department. The committee reviews the appointments of all full time , part time, and clinical faculty. Faculty candidates present a complete file containing a curriculum vitae, a letter from the Regional Chair to the Dean recommending the candidate, and three letters of recommendation.

Call Schedule

Faculty are present 24 hours per day for hospital service. Upper level residents serve on night float rotation that involves two blocks of fifteen nights without daytime obligation during the 3 rd and 4 th postgraduate years. The night float resident is relieved on week-ends by another upper level resident which results in these residents having a 2-3 night call obligation per month when not on night float.

During the 1 st and 2 nd post graduate years, residents rotate call on an average of 5-6 times per month.

Third year clerkship medical students, fourth year elective medical students, and family medicine residents supplement the call coverage team.

The night float systems allows for sufficient coverage to account for vacation, sick leave, and educational absences of residents and allows residents to have a very reasonable work hour week with a minimum of one full day off each week.

Call responsibilities involve coverage of labor and delivery, emergency room calls, and coverage of all hospitalized patients including subspecialty patients.

Participating Institutions

Northwest Texas Healthcare System is committed to and supports graduate medical education. This hospital is a tertiary care facility which provides care for patients in the upper 27 counties of the Texas Panhandle, the Oklahoma Panhandle, western Oklahoma, eastern New Mexico, and southern Kansas. Northwest Texas Hospital serves as a high risk referral center for this vast region and provides helicopter transport and a state of the art neonatal intensive care service. The affiliation agreement between Texas Tech University and Northwest Texas Healthcare System provides a partnership in the development of high standards in medical care through education, service, and research. Northwest Texas Health Care System also serves as a sponsoring member of our Women's Health Research Institute. Graduate medical education funding and faculty support are provide through Northwest Texas.

Baptist St. Anthony's Healthcare System is a private non-profit institution that supports our private gynecologic surgery experience and gynecologic oncology service. Our family medicine program uses this hospital as its primary teaching facility and our department serves that department in a consultant capacity.

The Harrington Cancer Center is an outpatient facility that provides support for our gynecologic oncology service and collaborates in research efforts. The facility has radiation therapy, outpatient chemotherapy and outpatient gynecologic oncology services. Surgical cases are performed in both hospitals.

Our faculty serve as consultants to the Veterans Administration Hospital and residents occasionally see patients with the faculty or assist faculty with surgery in this hospital.

Our department provides the medical directorship and support for the Planned Parenthood system in the Texas Panhandle. These clinics conduct preconceptional counseling, family planning, and menopausal services. Our faculty and residents staff clinics in Amarillo, and provide consultative services for the 17 outlying clinics.

Educational Experiences

Our residency program is divided into three continuity teams consisting of four residents, one from each level of training. The resident remains on the same continuity team and sees the same panel of patients throughout the four years of training. Each continuity team is responsible for managing its own general obstetrical and gynecologic patients in much the same manner as any general practice of obstetrics and gynecology. Each team has an operating day, labor and delivery day, and its own continuity clinics. Continuity teams rotate through two month blocks which emphasize specific areas of resident education that are related to the individual expertise and interests of the faculty and the need to fulfill all educational objectives of the program. Each two month block is repeated each year for a total of four months on each block.

Block 1- Two months

Team Emphasis: General obstetrics and gynecology, gynecologic oncology, urogynecology, pelvic reconstructive surgery

Resident Responsibilities and Educational Objectives: All residents will continue to participate in the primary care of their continuity patients but the team will concentrate on the above areas of interest.

4 th Year Resident: Major surgical experience in oncology, urinary incontinence, pelvic relaxation; pre and post operative care, direct teaching rounds and patient care provided by the team

3 rd Year Resident: Major surgical experience in oncology, urinary incontinence, pelvic relaxation, and general gynecology: pre and post operative care; responsible for gynecologic oncology and pathology conferences.

2 nd Year Resident: Assist in surgery and serve as primary operator on minor cases and selected general gynecologic major cases; pre and post operative care conduct colposcopy clinics; one month on Intensive Care rotation

1 st Year Resident: Assist in surgery, perform selected minor cases, pre and post operative care; one month on Emergency Room rotation

Block 2- Two months

Team Emphasis: General obstetrics and gynecology, high risk obstetrics, genetics, ultrasound, bone densiometry, and mammography

Resident Responsibilities and Educational Objectives: All residents will continue to participate in the primary care of their continuity patients but the team will concentrate on high risk obstetrical management and imaging.

4 th Year Resident: Management of high risk patients: antepartum and postpartum care; ultrasound, genetics; direct teaching rounds and patient care provided by the team

3 rd Year Resident: Perform genetic amniocentesis, ultrasound, high risk obstetrics; prepare maternal-fetal medicine and neonatology conferences

2 nd Year Resident: Labor and delivery management, operative obstetrics, antepartum and postpartum care

1 st Year Resident: Neonatal Intensive care-2 weeks; Neonatal Advance Life Support Certification; low risk obstetrical care; one month of imaging and special procedures (ultrasound, mammography, bone densiometry, urodynamics)

Block 3- Two months

Team Emphasis: General obstetrics and gynecology, reproductive endocrinology and infertility, private gynecologic surgery

Resident Responsibilities and Educational Objectives: Emphasis on all aspects of REI. All residents will continue to participate in primary care of their continuity patients.

4 th Year Resident: Work with private practitioners; direct the team, perform major cases on team patients, direct teaching rounds

3 rd Year Resident: Work with private practitioners; perform major cases on team patients, work with infertility team staff, prepare REI conferences

2 nd Year Resident: Learn basic endocrinology and infertility, assist in surgery, perform selected major cases

1 st Year Resident: 2 months on family medicine including geriatrics, 2 months on internal medicine

Normal Obstetrics:

With faculty supervision, residents of all levels provide complete prenatal and postpartum care for low risk patients at the University Physicians of Texas Tech Amarillo outpatient facility. These patients are all seen through continuity clinics and are followed by the same resident throughout the pregnancy. In the event of a resident's absence, patients are seen by another resident team member. All of our resident inpatient care is performed at Northwest Texas Hospital, which is a tertiary care center, and the major teaching hospital for Texas Tech University Health Sciences Center at Amarillo. The residents deliver approximately 2000 babies per year and are supervised by in-house faculty. Normal obstetric deliveries, which include the use of outlet forceps and vacuum extraction, are performed by junior house officers under the direct supervision of an upper level resident and in-house faculty.

All unassigned obstetrical patients who present at Northwest Texas Hospital are cared for by the Texas Tech Ob/Gyn residents and faculty.

First year residents on the obstetrical service learn to manage normal laboring patients and are also instructed in interpretation of fetal heart tracings, the use of basic ultrasound procedures, identification of high risk factors, and obstetrical anesthesia and analgesia. They are expected to manage patients in labor and delivery areas and keep timely notes on all patients. The second year obstetrical resident, who has the responsibility for managing labor and delivery, is available for immediate supervision in addition to a faculty member who is available at all times.

High Risk Obstetrics:

Northwest Texas Hospital is a tertiary care center and the major teaching hospital for Texas Tech Unversity Health Sciences Center. The 30 bed neonatal intensive care unit is staffed by neonatologists, all of whom are full time faculty of the Department of Pediatrics of Texas Tech. Our department has the only maternal fetal medicine specialists in the region and virtually all of the high risk obstetrical patients are managed by the Texas Tech Ob/Gyn Department. The referral area for high risk patients extends beyond Amarillo to the upper 27 counties of the Texas Panhandle, the Panhandle of Oklahoma , western Oklahoma, southern Kansas, and eastern New Mexico. In addition to ground transportation, Northwest Texas Hospital operates the only helicopter transport service in the region. Our neonatology service also provides a transport team. The resident team, consisting of one resident from each level of training, is the recipient of the high risk patients. The chief resident on the team is responsible for the overall management of the patients under the direct supervision of faculty. The third year resident's major inpatient duties include the care of the high risk antepartum patients, as well as those in labor. The second year resident, along with the intern, work in labor and delivery under upper level resident and faculty supervision, and also conduct rounds on the postoperative cesarean section and tubal ligation patients. The first year resident works with the team but is primarily responsible for the low risk patients.

Our antepartum testing center provides non-stress testing, contraction stress testing, biophysical profiles, and Doppler flow studies. Transabdominal and vaginal ultrasound are available for fetal diagnosis. Ultrasounds are performed by residents at all levels under the supervision of our maternal fetal medicine faculty and with the help of the department's experienced sonographers. Ultrasound-directed amniocenteses are performed in the antenatal testing center for the confirmation of fetal lung maturity, and mid-trimester amniocenteses are performed for various maternal and fetal problems. Residents are also able to participate in interventional procedures for fetal therapy when these are performed by maternal fetal medicine faculty.

The high risk obstetrical outpatients service is located in the University Physicians of Texas Tech Amarillo outpatient facility. Approximately 80 patients are seen each week by the resident team under supervision of faculty. Patients seen in these clinics represent a variety of problems including diabetes, thyroid disease, chronic hypertension, and preterm labor.

The Ob/Gyn Department works very closely with the neonatologists and the Department of Pediatrics. A monthly perinatal conference is held jointly with that department. Our department has a weekly Morbidity and Mortality conference in which high risk patients are regularly discussed. Residents interact on a regular basis with the neonatalogists regarding the status of problem babies.

Topics of high risk obstetrics are regularly included in our didactic sessions and teaching rounds. Additionally, residents participate in research protocols that address high risk obstetrical problems.

Neonatal Resuscitation:

During the first year, obstetrical and gynecology residents rotate on the neonatal intensive care unit which is staffed by Texas Tech neonatologists. The residents are available for neonatal resuscitation, the establishment of basic monitoring of infants, and ventilator support. They also participate in the day-to-day management of the newborns during this rotation. Residents are required to complete Neonatal Advance Life Support during the first year. Our program requires that this certification be renewed during the latter months of the fourth year prior to completion of residency training.

Operative Gynecology:

Gynecologic patients requiring surgery come to Texas Tech from a number of sources, including the following:

  1. Emergency room at Northwest Texas Hospital
  2. The urgent care centers at Baptist St. Anthony's Health System
  3. The Texas Tech out patient facilities (resident continuity clinics)
  4. Northwest Texas sponsored clinics
  5. Veterans' Administration Medical Center
  6. Neal Unit of the Texas Department of Corrections
  7. Planned Parenthood Clinics
  8. Inpatient consultative service at Northwest Texas Hospital
  9. Referrals from other Texas Tech departments
  10. Referrals from area private physicians

Benign gynecologic surgery is performed by each continuity team on an on-going basis. Each team has an assigned operating room day and performs the surgery under the supervision of the faculty assigned to the team. Patients who are candidates for gynecologic surgery are seen in the outpatient clinics and examined with the attending faculty surgeon. They are evaluated, counseled and then scheduled for surgery after a management plan has been developed. The extent of the resident's involvement in the surgical procedure depends upon their skill level and the complexity of the surgery. It is expected that development of surgical skills will occur progressively over the four years of residency training. The Program Director reviews each resident's surgical experience during quarterly evaluations. Residents are asked to review their surgical case list during the last quarter of each year. With this information and knowledge of the educational objectives in gynecologic surgery, residents can identify specific case types in which they need further experience.

Private gynecologic surgical cases are used to broaden the resident's experience. Residents work with a variety of local gynecologists and serve as both surgical assistants and primary operators depending on their level of expertise and the complexity of the cases. Pre-operative care on these patients is limited since the patients are followed in private physicians' offices. However, the resident participates in post-operative care at the discretion of the private attending. Private patients of full time faculty are always attended by a resident surgeon.

Gynecologic surgical topics are regularly included in the departmental didactic sessions. Cases are presented for discussion in a weekly morbidity and mortality conference. The chief resident on each team, along with the faculty attending, chooses topics for discussion in formal teaching rounds that are held at least once weekly. The department is frequented by visiting professors, many of whom discuss gynecologic surgical related topics. Gynecologic surgical pathology is reviewed in a monthly conference.

Gynecologic Malignancies:

The gynecologic oncology service is staffed by two highly qualified, sub-specialty board-certified faculty surgeons. Oncology cases are performed in both hospitals, but a larger number are admitted to Baptist St. Anthony's Health Care system because of the relationship of the Harrington Cancer Center to that hospital. The Harrington Cancer Center provides outpatient services including radiation therapy, outpatient chemotherapy, and psychosocial services. Residents covering this service participate in the inpatient, operative, and outpatient care of all patients with gynecologic malignancies. The gynecologic oncology service is a referral base service, receiving patients from many of the practicing physicians in the region.

Residents participate in the diagnostic work-up and staging of new malignancies. Additionally, the residents learn all oncological outpatient diagnostic procedures such as colposcopy, colposcopic-directed biopsies, conization, cryosurgery, and vulvar biopsies. They also gain experience in the interpretation of CAT scans and various diagnostic imaging studies. The residents are provided with the opportunity to follow patients who have undergone radiation treatment, and/or chemotherapy and consequently see complications that are associated with these modes of therapy. Many of the oncology patients are referred from other physicians and the residents are exposed to doctor-doctor interaction that will become an important part of their future practice.

The inpatient experience involves the surgical management of all gynecologic malignancies and includes exposure to radical vulvectomies, radical vaginectomies, radical hysterectomies, node biopsies and dissection, pelvic exenterations, and bowel and urinary track procedures such as colostomies and ureteral diversions. Since many of these patients are elderly and have multiple medical problems in addition to their complex surgical management, the residents often gain intensive care unit experience. The service is intensely supervised and is a quality educational experience.

Infertility and Endocrinology:

Residents are exposed to infertility and reproductive endocrinology problems through their own continuity patients and through patients that are referred to our Reproductive Endocrinology and Infertility service. The department has an infertility team consisting of faculty, resident staff, infertility nurse, sonographers, and laboratory support. Our department has a highly productive endocrinology research laboratory, and has in-house capability for the broad range of endocrinologic assays. These resources are available for patient service, research and educational purposes. Residents actively participate in a variety of endocrinology related research projects and have a record of presentations and peer-reviewed publications in this area.

Residents assigned to this service are exposed to general reproductive endocrinology problems, ovulation induction, use of GnRH analogues, follicular sonography, intrauterine insemination with washed semen, hysterosalpingography, saline hysterosonograms, endometrial biopsies, and office hysteroscopy. Surgical procedures for infertility are performed by the attending faculty or the upper level resident depending upon the level of expertise. The department does not perform in-vitro fertilization procedures but works closely with programs at the University of Texas Southwestern in Dallas, the Lubbock campus of Texas Tech University Health Sciences Center, as well as other IVF centers to provide this service. Patients are followed for follicular development by our service and the in-vitro procedure is completed at the patient's choice of centers.

Reproductive endocrinology and infertility topics are presented in a monthly conference to the entire department and additionally are included in small group sessions with the continuity team assigned to the endocrine service.

Pathology:

The department has one formal pathology conference each month, at which time a variety of gynecologic pathology issues are discussed including review of surgical specimens. The third year resident covering the oncology service is responsible for the organization of the monthly pathology conference.

Our gynecologic oncology faculty, Dr. David Barclay and Dr. Rusty Robinson, are knowledgeable in the pathology of gynecologic malignancies and provide additional instruction in this area to our residents. The Director of Benign Gynecology provides instructional materials for the residents including CD ROMS, slides and videos covering all areas of gyn pathology. All residents are responsible for review of the pathology of surgical specimens on their operative cases and for liberally consulting with the pathologist regarding their findings.

Colposcopy clinics are attended by residents covering the oncology service. Correlation is made between the abnormal pap smear, colposcopic findings and histologic specimens obtained by directed biopsy or LEEP conization.

All residents have the opportunity to learn pathology at the weekly Tumor Board Conference, conducted in conjunction with the gynecologic oncology service. Residents covering the gynecologic oncology service are expected to attend this conference.

Diagnosis and Management of Breast Disease:

The breast examination, diagnostic techniques, and management of benign and malignant breast disease are topics that are covered in our didactic lecture series. Residents are expected to perform a breast examination on all obstetrical and gynecologic patients, teach self-examination, and arrange for appropriate screening procedures. Residents are also taught to aspirate breast masses by our faculty when applicable. Persistent masses, or those with any features of malignancy, may be referred to our surgical oncologist. Arrangements are made for the resident to participate in the consultation, and if fine needle aspiration, open biopsy or mastectomy is recommended, the resident has the opportunity to assist in those procedures since we do not have surgery residents at our institution.

Urogynecology and Pelvic Floor Dysfunction:

Drs. Ron Hodges and Mindy Luck has a special interest in urogynecology and urodynamics. Under the supervision of Drs. Hodges and Luck, all of the urodynamics testing methodologies are available to the patients presenting with urinary tract dysfunction. Residents learn to perform and interpret urodynamic studies under Drs. Hodges and Luck supervision. When surgical procedures are indicated, the resident conducts the preoperative assessment and performs the appropriate surgical procedure under faculty supervision. Four other senior faculty members with extensive surgical experience are available, along with Drs. Hodges and Luck, to perform these procedures. Residents also have available to them the extensive expertise in pelvic reconstructive surgery of one of our oncologists, Dr.David Barclay. Surgery methods may include anterior/posterior vaginal repair, retropubic urethral suspension procedures, needle procedures, sling procedures, low tension tape procedures, abdominal and vaginal enterocele repair, sacrospinous ligament fixation, sacrocolpopexy, and rectovaginal fistula repair. Residents conduct preoperative and postoperative care under the direct supervision of the faculty. Residents are also exposed to and learn the placement of pessaries and pelvic floor exercises used in the management of pelvic floor dysfunction. Topics related to urogynecology and pelvic floor dysfunction are included in our didactic series.

The department has an active biofeedback program for treatment of incontinence (Incon Therapy) and our nursing staff has been certified to conduct this therapy. Residents are exposed to this initially at the first year level and learn the indications and conduct of this therapy. Subsequently, they are able to identify those incontinence patients that might be candidates for this type of therapy.

Genetic Disorders:

Genetic counseling services and antenatal genetic testing are provided by our maternal fetal medicine service. Residents participate with faculty in counseling and genetic amniocentesis. When genetic abnormalities are found, the resident participates in counseling the patient regarding outcome and possible therapy. Residents at the first year level learn basic ultrasonography during their imaging rotation. Genetic disorders are regularly discussed in didactic sessions and presented in joint conferences with the pediatric department. In addition, our department invites visiting professors to present genetic topics. Dr Golder Wilson, board certified in medical genetics, supervises the departments genetics program.

Ultrasonographic Services:

Ultrasonographic services in the Department of Obstetrics and Gynecology consist of obstetrical ultrasound, gynecologic ultrasound, Doppler flow vascular, studies, fetal echocardiography, follicular sonography, saline hysterosonography, and selected ultrasound guided intrauterine therapy procedures. The ultrasound service is directed by Dr. James Van Hook, who is board certified in MFM.

During the first year of residency, one month rotation is devoted to learning various imaging and technical skills that will be used throughout training. At that level, residents work with Dr. Van Hook to learn basic ultrasound skills. The department uses state of the art ultrasonographic equipment in all of our clinical areas and employs three experienced certified sonographers who are valuable to the resident's educational process. Residents use ultrasonography under faculty supervision in the labor and delivery area, emergency rooms, antenatal testing unit, and other out patient facilities. Their exposure to ultrasonography is extensive and progressive. The program is certified by the American Institute of Ultrasound in Medicine.

Family Planning :

Family planning services are provided by the residents, under faculty supervision, for their continuity care patients. Dr. Moss Hampton serves as the Medical Director for Planned Parenthood of Amarillo & the Texas Panhandle, which includes two clinics in Amarillo and 17 throughout this area of West Texas. Family planning, components of the sexual history, and preconceptional counseling and screening are considerd a part of primary care and gynecologic care. Principles of selection and instruction in the use of family planning methods are taught in scheduled lectures at our regular didactic sessions on Tuesday and Friday mornings as well as by faculty in the clinical setting. Residents learn the techniques involved in insertion of intrauterine devices, management of injectable contraceptives, oral contraceptives, and other methods of birth control. Residents also perform postpartum and interval permanent sterilization procedurees after appropriate patient counseling and acquisition of informed consent. All steps of this process are under faculty supervision. Family planning counseling is initiated early in the pregnancy by the resident and nurse practitioners and is followed by contraceptive method selection during the postpartum period. Our Clinical Trials division is actively participates in a variety of contraceptive trials in which residents recruit and follow patients.

Elective termination of pregnancy is not performed in this community and consequently, faculty or residents only perform terminations for clear medical indications. Elective abortions are referred to either Lubbock or Dallas and residents follow-up with their patients. Residents are taught the principles of pregnancy termination in didactic sessions. Residents gain experience with mechanical cervical dilation techniques, suction curettage, and mid-trimester terminations from managing patients with a diagnosis of missed abortion, fetal demise, or fetal anomalies. Residents are encouraged, but not required to participate in medically indicated pregnancy terminations.

Psychosexual Counseling:

Residents are exposed to a large number of patients in need of psychosexual counseling. Our area has a very high teenage pregnancy rate and residents develop close relations with many of these young women. Our continuity of care system allows for a longitudinal doctor-patient relationship with women of all ages. Our faculty consists of experienced practitioners who actively encourage the resident staff in the proper identification of high risk behaviors, the detection and prevention of sexually transmitted disease, and counseling patients regarding sexual dysfunction. Dr. Robert Kaufman has a special interest in depression and its role in gynecologic disorders and provides both didactic lectures and clinical consultation for the residents. Rape crisis management, domestic violence, stress and sleep disorders are included in our Grand Rounds series and as didactic lecture topics. The department uses both internal faculty resources and visiting lecturers to deliver these topics. Our department works closely with our behavioral sciences faculty and with counseling services in both hospitals.

Management of Critically Ill Patients:

Obstetrical patients requiring intensive care may be managed in the Labor and Delivery area or in the medical intensive care unit. Residents provide care under the direct supervision of faculty and appropriate consultants. If patients are transferred to the intensive care unit, the residents work directly with the intensive care team. Second year residents spend one month in the intensive care unit working with a variety of intensive care patients. Additionally, many of our critical care patients come from the gynecologic oncology service. These patients are transferred to the surgical intensive care unit where they are managed in conjunction with the oncologists on our faculty and other consultants. Residents participate directly in the continuous management of these patients. Didactic lectures concerning critical care issues are presented by our oncologists, by other faculty members, and by visiting lecturers. Dr. James Van Hook is board certified in critical care OB/GYN, has a special interest in critical care management and provides teaching/consultation in this area.

Emergency Medicine:

Northwest Texas Hospital, our major teaching facility, has a full service trauma center. During the first year, residents rotate in the emergency room under the supervision of Dr. Stephen Newmann and his emergency room staff physicians who are all board certified in emergency medicine. The residents directly participate in the evaluation and management of emergency conditions in the adult. In addition, the residents serve as primary care providers for patients with problems such as hypertensive crisis, asthmatic attacks, chest pain, G.I. bleeding, acute abdominal problems, and trauma. Throughout residency, residents serve as consultants to the emergency room for obstetrical and gynecologic problems.

Residents are required to become Advanced Cardiac Life Support Certified during the first year of residency and this is renewed prior to completion of residency.

Primary and Preventive Care:

Residents are assigned to continuity teams at the first year level and continue to work with the same team and the same panel of patients for the entire four year period. Consequently, they are involved in the delivery of primary and preventive care on an ongoing basis. The department has developed and maintains an extensive syllabus that includes materials on all educational objectives in primary and preventive ambulatory health care. This syllabus is given to first year residents and serves as a clinical guide and learning resource. First year residents are assigned to two months of family medicine, one month of Emergency Room, and one month of Neonatal Intensive Care. First year residents also have a one month rotation which includes learning bone densitometry, mammography, and incontinence management. Primary care experience also occurs on the emergency rotation and the geriatric rotation portion of family medicine. This background prepares the resident to direct the primary care of patients in continuity clinics. All resident patients in our department are seen through continuity clinics. Second year residents are assigned to the Internal Medicine Intensive Care Unit for one month. A structured primary care lecture series is presented during the entire four year long residency.

Residents are taught to evaluate patients for lifestyle factors such as smoking , exercise, substance abuse, and domestic violence. Information is elicited regarding immunization status and immunizations provided. Counseling for prevention of sexually transmitted disease, contraception, and screening for disease is offered. Residents learn screening for osteoporosis, cardiovascular disease, and other debilitating disorders. Hormone replacement therapy is administered under the direction of faculty.

Residents receive instruction and experience in ambulatory care in all our patient care sites. Dr. Marjorie Jenkins, an internist, has a part time appointment in our department. She teaches primary care and preoperative evaluation of medical problems in the gynecology clinics.

Basic Medical Epidemiology and Statistics:

Residents gain first hand knowledge of the utilization of statistical methods as they prepare their own research projects. The department conducts a monthly journal club in which residents are expected to critically analyze research methods. Epidemiologic studies are frequently included for presentation and faculty members actively participate in the discussion. The department also invites outside lecturers to discuss specific scientific methodology.

Epidemiology of disease as it relates to women's health is a distinct part of our primary care curriculum. Residents also have the opportunity to participate in projects of the Women's Health Research Institute related to epidemiology.

Ethics and Medical Jurisprudence:

Ethics is approached in a didactic way and as a practical part of patient care. Teaching conferences are conducted, including Grand Rounds presentations, devoted to specific ethical topics. The Texas State Board of Medical Examiners requires testing in medical jurisprudence as part of the licensure examination. Most of our residents complete licensure in this state and consequently must study for and pass this examination. There is also an ethics continuing medical education requirement for licensure renewal in Texas that is satisfied by inclusion of ethics topics in courses that are conducted by the department and other state meetings attended by our residents.

Our curriculum includes case examples from EXPLORING ISSUES IN OBSTETRICS AND GYNECOLOGIC MEDICAL ETHICS published by the Association of Professors of Gynecology and Obstetrics. Perinatal ethical issues are also discussed in our monthly joint neonatal conference with the pediatric department.

Continuity Experience for Residents:

Beginning in the first year, residents are assigned to a continuity team consisting of one resident from each level and faculty physicians. The resident will then follow the same panel of patients throughout the four years of residency training. The continuity team works in the same way as a group practice with each member having his or her own patients with coverage for these patients by their team partners. In the event of the absence of a resident, members of the team will see patients for that resident until his or her return. Residents deliver their own obstetrical patients whenever possible, participate in the operative management of their own patients, and provide follow-up. Residents are responsible for the primary and preventive care of their patient panel. All patients appointed to our resident outpatient facilities are assigned to a specific resident physician for inclusion into the continuity system. When patients have requirements for sub-specialty care, consults are made to the sub-specialist and the resident is expected to continue to participate in the care and provide follow-up, either as co-management or primary management.

BENEFITS



For all benefits and conditions of employment including information concerning leaves of absences and medical malpractice insurance, please visit www.remedy.ttuhsc.edu/GME/ .

INSTITUTIONAL BENEFITS




SALARIES

PGY-I $38,666 PGY-II $39,927 PGY-III $41,188 PGY-IV $42,448

MAJOR MEDICAL EXPENSE INSURANCE

Coverage for allowed medical expenses incurred, including professional fees.

Plan 1, $500 deductible

$25 Office Visit Copay and 90% Coinsurance

Dependent coverage available

LONG TERM DISABILITY

Helps replace lost earnings in the event of an accident or illness.

$1,500 monthly benefits, 30-day waiting period.

TERM LIFE INSURANCE

A vital segment of any financial protection plan:

$100,000 benefits on resident

$10,000 benefits on spouse (optional)

$5,000 benefits per child (optional)

DENTAL INSURANCE

Allows you to attain and maintain good dental health.

$25 deductible Dependent coverage available

DEPARTMENTAL BENEFITS




PROFESSIONAL ORGANIZATIONS

Your membership dues to The American College of Obstetricians and Gynecologists

will be paid by the Department. Participation in this organization is required.

PAID VACATION TIME

PGY-I and PGY-II residents receive 15 days paid vacation;

PGY-III and PGY IV residents receive 20 days.

The time off must be approved by the Program Director and Chief Resident.