Educational Experience
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.
Obstetrics
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.
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 neonatologists 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.
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.
Gynecology
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
- TTUHSC 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 indispensable 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.
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.
Subspecialties
Dr. Thahir Farzan, a board-certified gynecologic oncologist, joined the Harrington Cancer Center staff in July 2012. Dr. Farzan performs the full range of gynecologic oncology surgeries including robotic surgery. Residents are expected to assist Dr. Farzan in the surgical and postoperative management of his cases.
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.
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, 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.
BSA and NWTH each operate multispecialty cancer conferences that review histologic specimens. Residents are encouraged to attend.
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.
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 the breast surgery service. 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.