Division of Gynecology
Urogynecology/Laparoscopy Advanced Pelvic Surgery Experience
Division of Maternal Fetal Medicine
Division of Gynecologic Oncology
Division of Reproductive Endocrinology and Infertility
Minimally Invasive Surgery Training
The Division of Gynecology at Carolinas Medical Center is focused on educating residents and medical students in ambulatory and surgical gynecology. This division has five ob/gyn specialists. Our plan is to hire two more faculty members in the next 12 months.. The division is involved in resident education across the entire spectrum from the operating room, to the ambulatory clinic, to labor and delivery and into the classroom. While maintaining broad skills, each of the division members have special expertise in several niche areas such as urogynecology, laparoscopy, pediatric and adolescent gynecology and gynecologic ultrasound.
It is our goal to provide our residents with exposure and experience in all facets of benign gynecology. Our ambulatory gynecology clinics, which evaluate over 5,500 patients each year, provide experience in management of conditions such as contraception, sexually transmitted infections, abnormal uterine bleeding, vaginal infections and adnexal masses. In the operating room, we strive to give the resident a strong foundation of good surgical skills and habits from which to expand. We provide experience in all forms of vaginal, abdominal, laparoscopic and hysteroscopic surgery. This experience is enhanced through the ability to work with local private physicians in caring for their gynecologic patients.
The gynecology team consists of a PGY-2, PGY-3, and PGY-4 resident. The PGY-2 resident is responsible for inpatient care, emergency department and in-house consultations, assists with major procedures, and performs most outpatient procedures such as tubal ligation, dilation and curettage and operative hysteroscopy. The PGY-3 and PGY-4 residents divide their rotation between benign gynecology and urogynecology. The benign gynecology senior resident is responsible for all inpatient care and performs all major procedures. This resident is also responsible for supervision of the gynecology team. The resident on the urogynecology service works with our three female medicine and reconstructive surgery faculty members mainly at CMC-Mercy which is 2 miles from the main campus.
The first year urogynecology experience within the general gynecology rotation includes an introduction to the anatomy of pelvic support and continence, staging of prolapse with the POP-Q system and urodynamic testing and pelvic physiotherapy. More extensive and in-depth training in urogynecology takes place during the PGY-3 and PGY-4 years. During each month rotation, the resident participates in a weekly urogynecology clinic evaluating patients with prolapse symptoms and urinary incontinence. Instruction is given in pessary fitting, cystometry and interpretation of multichannel urodynamics. A month rotation exposes residents to both the ambulatory and operative settings, with operative experience in suburethral sling placement TOT/TVT, laparoscopic pelvic reconstruction, abdominal pelvic reconstruction and vagina obliterative procedures.
The responsibility for the education and supervision of residents and medical students for the Obstetrics and High Risk Obstetrics rotations is shared between the Generalists Faculty and the Maternal Fetal Medicine Division. Carolinas Medical Center has approximately 7,000 deliveries per year and serves as the tertiary referral center for nine surrounding counties. Thus, the obstetric experience is extensive and robust.
Residents are trained in prenatal care, obstetrical triage, and management of uncomplicated labor in the PGY-1 year. The PGY-2 residents learn to manage all patients in labor and delivery, is the primary surgery for C-sections, participates in diabetic and high-risk obstetrical clinics, begin to learn the principles of operative vaginal deliveries. The second year obstetrical resident also participates in the Diabetic and High Risk Obstetric Clinics and obtains extensive experience in labor management and operative obstetrics. The third and fourth years concentrate on inpatient and outpatient High Risk Obstetrics. Additionally, the third and fourth years offer the unique opportunity to be involved in a variety of complex fetal surgeries. The CMC Charlotte Fetal Care Center is also one of approximately 12 centers in the country that perform selective fetoscopic laser photocoagulation surgery for Twin-Twin Transfusion Syndrome.
The Division of Gynecologic Oncology is composed of five board certified gynecologic oncologists, four of whom operate exclusively at CMC. Our faculty members annually evaluate approximately 1200 new patients and perform over 1040 surgeries. The majority of cases are done as minimally invasive surgery, either via advanced laparoscopic or da Vinci robotic technology. The residents are integral members of the operative team, with the additional learning experience if our state of the art minimally invasive dry lab. The teaching emphasis is learning pre-operative work-up of gyn malignancies, operative technique and anatomy, and post-operative care; didactic sessions are integrated during the Thursday morning teaching sessions and tumor boards are conducted jointly with our gyn pathologists and members of the radiation oncology division.
CMC is a primary site for NCI/GOG clinical trials, as well as industry studies. The new Levine Cancer Institute will have 80 infusion chairs, as well as a Phase 1 unit to expand our ongoing work which will offer our patients access to the latest therapies for their gynecologic malignancies. The inpatient service averages 12-15 patients and is run by a PGY-4, 2, and 1, augmented by medical students, and AIs from around the country; for continuity of care the attendings are on service a week at a time.
Finally, the division has a research lab in the Cannon Research facility on campus, as well as having a long standing relationship on integrated projects with the University of North Carolina at Charlotte. Given the abundance of clinical material there is ample opportunity for research.
The Division of Reproductive Endocrinology and Infertility (REI) within the Department of Obstetrics and Gynecology at Carolinas Medical Center is dedicated to the highest quality training of OB/GYN residents through interaction within a full-service REI clinical practice, formal didactic instruction and clinical and basic research. The Division is comprised of four subspecialty board-certified REI physicians. Residents are involved with patients representing a wide spectrum of disorders including gynecologic endocrinopathies, abnormalities of sexual development, infertility, recurrent pregnancy loss, genetic reproductive failure and problems in menopausal medicine. Residents in OB/GYN are expected to have thorough training in the selection and preparation of patients for in-vitro fertilization and to be familiar with advanced reproductive procedures through our Program for Assisted Reproduction. This experience will provide clinically applicable knowledge in gamete development, embryology and the physiology of the hypothalamic-pituitary-ovarian axis.
Our philosophy is that many fundamental clinical concepts involved in gynecology, early pregnancy and office practice require a thorough understanding of REI. The REI faculty is therefore also involved in teaching and consultation for cases of amenorrhea, abnormal uterine bleeding, endometriosis and advanced endoscopic procedures. REI and Gynecology faculty have developed formal didactic and laboratory instruction in a resident endoscopic teaching course.
The formal REI resident rotation occurs during 2 months period in the third year of residency training. An individual resident will be involved in the evaluation and management of private patients referred to REI faculty and will have primary clinical responsibility in their own REI staff clinic with one-on-one faculty supervision. Residents will obtain direct experience in ultrasound and hormonal monitoring for cycles of ovulation induction, saline instillation sonography, hysterosalpingography, and intrauterine inseminations. Residents will participate in a broad range of both outpatient and inpatient surgeries related to REI. Time is allowed for directed reading for preparation of REI lectures for resident teaching conferences. For those residents seeking to pursue fellowship in REI, additional clinical experience and involvement in available active clinical and basic research projects is encouraged.
A curriculum has been developed to assist residents in developing a solid foundation in minimally invasive surgical techniques. An animal lab is conducted yearly to assess the resident's skill level.
The Carolinas Simulation Center is now available to assist with surgical training. Residents are required to become proficient in eight tasks on the virtual reality trainer and seven tasks on the surgical box trainer. These tasks have assisted residents in improving their hand-eye coordination.
Recently, a birthing simulator was added to the Simulation Center. This simulator will allow residents and students to learn the basics of vaginal delivery and operative delivery with forceps or the vacuum. The simulators reproduce different clinical fetal heart rate issues that allow the residents to formulate treatment plans.
The experience in laparoscopic surgery for our residents had significantly increased in the last five years. Graduates average 120 operative laparoscopies. Residents can expect to participate in 70 laparoscopic hysterectomies. Participation in robotic surgery was initiated in 2007.
In 2007-2008, the department initiated its Laborist Program. Laborists function in a similar fashion to the Internal Medicine Hospitalists; ensuring consistent and continuous 24-hour coverage of Labor and Delivery. Benefits of the laborist program as demonstrated in other facilities include improved patient safety, increased patient and physician satisfaction, improved residency education and decreased malpractice claims.