ObstetricsAll 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 4 weeks.
With faculty supervision, residents of all levels provide complete prenatal and postpartum care for low risk patients at the 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 or by one of our nurse practitioners or physicians assistants. 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 2200 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 house officers under the direct supervision of 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 upper level 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.
All 1st year residents are required to participate in the Advanced Life Support in Obstetrics (ALSO) course given by Dr. Paul Tullar. This is an outstanding course that prepares residents for a variety of obstetrical emergencies.
High Risk Obstetrics
Northwest Texas Hospital is a tertiary care center and the major teaching hospital for Texas Tech University Health Sciences Center. The 30 bed Level 3 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 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 PGY-1 resident, work in labor and delivery under upper level resident and faculty supervision. 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, Doppler flow studies, and 3-D ultrasound. 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 AIUM-certified 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 performed by maternal-fetal medicine faculty.
The high risk obstetrical outpatients service is located in the Texas Tech Amarillo outpatient facility. Approximately 60-80 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, preterm labor, and fetal anomalies.
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 may participate in research protocols that address high risk obstetrical problems.
Genetic counseling services and antenatal genetic testing are provided by our maternal-fetal medicine service and geneticist. 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 department's genetics program.
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, selected ultrasound guided intrauterine therapy procedures, and 3D/4D ultrasound.
During the first year of residency, a one month rotation is devoted to learning various imaging and technical skills that will be used throughout training. At that level, residents work with faculty 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 was recertified by the American Institute of Ultrasound in Medicine in 2011 for an additional 3 years.