Family planning services are provided by the residents, under faculty supervision, for their continuity care patients. Family planning, components of the sexual history, and preconceptional counseling and screening are considered a part of primary care and gynecologic care. 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 procedures (including the Essure procedure) after appropriate patient counseling and acquisition of informed consent. 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. Nexplanon training is provided in the fall of each year.
Primary and Preventive Care
Residents are assigned to a continuity clinic at the first year level and continue to work with 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. 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. 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.
Northwest Texas Hospital, our major teaching facility, has a full service (Level III) trauma center. 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 (ACLS) certified during the first year of residency and this is renewed prior to completion of residency. Residents also are required to complete the Neonatal Resuscitation Program (NRP) which is offered yearly.
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, covering specific ethical topics. The Texas Medical Board 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.
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.
Residents are exposed to a large number of patients in need of psychosexual counseling. A psychotherapist is in the clinics for consultation time weekly. Our region has a 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. 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
Patients requiring intensive care may be managed in the Labor and Delivery area or in the medical or surgical intensive care unit. If patients are transferred to the intensive care unit, the residents work directly with the intensive care team. Additionally, many of our critical care patients come from the gynecologic oncology service.
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. An active journal club is run by residents and faculty and meets monthly.
Epidemiology of disease as it relates to women's health is a distinct part of our primary care curriculum.