Subspecialties
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 4 weeks.Gynecologic Malignancies
Board-certified gynecologic oncologists from Texas Oncology conduct 2 full-day clinics per month that are attended by residents. In addition, a 4-week rotation at UT-Southwestern Medical Center was introduced in late 2011. Residents spend one month during their 2nd and 3rd year on the gynecologic oncology service at UT-Southwestern.
Residents participate in the diagnostic work-up and staging of new malignancies. Additionally, the residents learn oncological outpatient diagnostic procedures such as colposcopy, colposcopic-directed biopsies, conization, and vulvar biopsy. They also gain experience in the interpretation of CT scans and other imaging studies. The residents are provided with the opportunity to follow patients who have undergone radiation treatment and/or chemotherapy, and consequently residents 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 tract 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 and 3D sonography, intrauterine insemination with washed semen, hysterosalpingography, 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 the Lubbock campus of Texas Tech University Health Sciences Center.
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 quarterly 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.
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.
Residents have the opportunity to attend the weekly Tumor Board Conference, conducted in conjunction with the gynecologic oncology service.
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. A breast consultation service was established by the Department of Surgery in 2009 under the direction of Dr. Rakhshanda Rahman, and residents have an opportunity to rotate onto her service. This center has recently been named a Center of Excellence at TTUHSC.