All residents spend approximately 50% of their educational time on the obstetrics and maternal-fetal medicine service and the other 50% on gynecologic and gynecologic subspecialties. Each rotation lasts one month.
Gynecologic patients requiring surgery come to Texas Tech from a number of sources, including the following:
Emergency room at Northwest Texas Hospital
The urgent care centers at Baptist St. Anthony's Health System
The Texas Tech out patient facilities (resident and faculty continuity clinics)
Women's & Children's Healthcare Center
Neal Unit of the Texas Department of Corrections
Family planning clinics
Inpatient consultative service at Northwest Texas Hospital
Referrals from other Texas Tech departments
Referrals from area private physicians
Benign gynecologic surgery is performed by residents of all levels under faculty supervision. 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 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 semi-annual evaluations. A DaVinci robot is available at one of the teaching hospitals, and annual inservices are provided to familiarize residents with robotic technology. At present, two faculty members are certified DaVinci surgeons.
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 of 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 periodic conferences.
Office hysteroscopy was introduced in 2010. At the completion of training, residents can expect to be competent in a variety of abdominal, vaginal, and laparoscopic surgeries. Office-based endometrial ablation will be added in late 2012.
Simulation has become an integral and indispensible part of medical and surgical training in the United States. Simulation allows students and residents to learn new techniques in the safety of a protected environment and to perfect existing skills. A consortium of Amarillo academic institutions have established a comprehensive simulation center, SimCentral, that features a variety of computerized models and dummies. Simulation training in adult and pediatric cardiovascular resuscitation, neonatal resuscitation, and a number of other emergency scenarios is available onsite. The Noelle obstetrical simulator is used to train students and residents in the management of shoulder dystocia, obstetrical hemorrhage, breech delivery, instrumental delivery, and intubation. Noelle is also used in the Advanced Life Support in Obstetrics (ALSO) course taught yearly on campus. Additionally, the department maintains a LapSim laparoscopic simulator inside the department. Residents are expected to complete a series of laparoscopic training modules on the LapSim during the course of training. The device is available 24-hours a day for practice and advanced learning.
Urogynecology and Pelvic Floor Dysfunction
Under the supervision of faculty, urodynamics testing is available to patients presenting with urinary tract dysfunction. When surgical procedures are indicated, the resident conducts the preoperative assessment and performs the appropriate surgical procedure under faculty supervision. 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 a member of the nursing staff has been certified to conduct this therapy.