Obstetrics Gynecology Los Angeles Medical Center - Curriculum
Post Graduate Year One – Intern Year
The focus of internship year is on attaining the medical knowledge and experience that will help provide the basis of comprehensive obstetric and gynecologic practice.
- 15 weeks of Obstetrics
- 2 five-week rotations on Labor and Delivery – Days
- 5 weeks on Labor and Delivery – Night Float
- 10 weeks of Benign Gynecology
- 2 five-week rotations
- 4 weeks of Family Planning-Planned Parenthood Los Angeles
- 4 weeks of Internal Medicine in the Intensive Care Unit
- 3 weeks of Reproductive Endrocrinology
- 3 weeks of Ultrasound – KP West Los Angeles
- 3 weeks of Primary Care
- 2 weeks of Neonatal Care/Nursery
Labor and Delivery Rotation
In the first-year obstetrical experience is gained during two 5-week rotations through labor and delivery. Interns begin their training learning about normal labor patterns and work closely with our Certified Nurse Midwives. They participate in the triage and consultation of labor and delivery patients and provide care for normal laboring patients. During this rotation, the intern receives graduated exposure to peripartum testing, basic ultrasound, vaginal deliveries and primary cesarean deliveries. The intern works within a PGY2 and PGY4 team for the duration of the rotation. Over time, the complexity of the cases assigned to the intern increases, as deemed appropriate by experience and individual clinical aptitude. There are also PGY1 and PGY2 residents from family medicine that rotate sequentially with our OBGYN interns and share weekend call schedules. All residents work with certified nurse midwives, generalist OBGYN faculty and staff, maternal fetal medicine specialists and family medicine attendings credentialed to work on Labor and Delivery.
Night Float Rotation
The PGY1 undertakes one 5-week night float rotation during which they mirror the labor and delivery daytime PGY1 responsibilities. The PGY1 works closely with the PGY2 and PGY3 night float team to provide seamless care to the patients overnight. The PGY1 overnight is primarily responsible for healthy patients presenting to OB triage and admitted for normal labor. The PGY1 is responsible for rounding on their own postpartum patients under the supervision of the postpartum rounding attending. In addition, the PGY1 is responsible to participate in formal sign out at 8am board rounds by presenting any laboring patient that they are following. The night float resident team works from Sunday night to Thursday night and has the entire weekend off.
Benign Gynecology Rotation
Interns spend two 5-week rotations on the benign gynecology service. The PGY1 is part of a team that includes a PGY3 and a PGY4 resident. The team works under the supervision of faculty OBGYN generalists as well as minimally invasive surgeons. The intern assists in providing care for admitted gynecology patients, undertaking emergency room consultations and participating in operating room cases. The goal is to gain knowledge and experience in the basics of gynecology evaluations and procedures. The intern is assigned appropriate operative cases by the PGY4 on a weekly basis. The intern is expected to be prepared for such cases and will be guided by the seniors on the gynecology team as well as by attendings during weekly case teaching. All care provided by the intern is under the direct supervision of a gynecology attending.
Reproductive Endocrinology Rotation
Interns spend 4 weeks rotating through the REI department, including time with pediatric and adult endocrine specialists. The rotation is designed to enhance the understanding of clinical reproductive endocrinology that provides the basis of so much of the care we provide to our female patients. The rotation involves a highly structured reading requirement as well as clinical experience in both adult and pediatric endocrine clinics.
Family Planning Rotation
Interns spend 4 weeks at Planned Parenthood Los Angeles providing contraceptive counseling, screening for and treating sexually transmitted infections, placing long-acting reliable contraceptives, and performing medical and surgical pregnancy terminations. Planned Parenthood is a community partner with which we share patient care and services. We are a Ryan Residency program and train all our residents in the provision of complex contraception, adolescent contraception, and first and second trimester abortion care.
This 3-week rotation is undertaken in first year to provide a strong base for further growth throughout the four years. It concentrates on review of ultrasound technology as well as appropriate indications for use. This rotation includes learning modules and simulation exercises. The clinical component includes patient assessments and competencies undertaken with the maternal fetal medicine specialist at the West Los Angeles Kaiser Permanente Medical Center.
Primary Care Rotation
During this 3-week rotation interns are assigned to work with the Family Medicine service. The intern participates in primary care clinic, in the UCLA Mobile Homeless Clinic and in the community at both Marshall and Belmont High Schools. The rotation provides invaluable experience in primary and preventative care for women along the entire spectrum of life, from pediatric to adolescent to geriatric care. In addition, this rotation places the resident in the community providing care to all levels of the social strata helping better understand the underpinnings of the social determinants of health.
Internal Medicine Rotation
The PGY1 undertakes a 4-week Internal Medicine rotation spent working in the Intensive Care Unit. This rotation prepares the intern to participate in the critical care of obstetric and gynecologic patients in the later years. During this rotation, house officers from the department of obstetrics and gynecology have the same clinical responsibilities and call duties as interns on the medicine service
Neonatal Care Rotation
Interns spend two weeks learning and performing “well baby” care under the supervision of faculty pediatricians and lactation consultants. The intern participates in pediatric postpartum rounding, attends deliveries, and counsels on postpartum breastfeeding strategies. The intern learns to perform newborn physical exams and initiate sepsis workups. Training in lactation and neonatal care are emphasized during this rotation.
Continuity clinics begin in internship year. The intern progresses from a shadowing experience to independent evaluations based on attaining competencies, individual aptitude, and patient care needs. A continuity clinic mentor attends and supervises every resident clinic. During intern year, this attending teaches and supervises all procedures in the clinic.
The goal is for independence by third year of residency, with continued review by the clinic mentor for maximizing learning opportunities. Continuity clinic is held weekly during each year of training, regardless of assignment to specialty services. Residents are encouraged to see their own postpartum, postoperative and post ED consultation patients in these clinics. To facilitate this goal, residents have a dedicated appointment clerk who assists them in scheduling their own patients into their own clinics.
Post Graduate Year Two
The focus of the second year of residency is on high-risk obstetrical care and specialty gynecology care. This year houses concentrated training in complex family planning and the expectation that each will pass their EMIGS (essentials of minimally invasive gynecologic surgery) exam. There is an oral exam at the end of this second year that must be passed in order to progress into third year.
- 20 weeks of Obstetrics
- 2 five-week rotations on Labor and Delivery – Days
- 2 five-week rotations on Labor and Delivery – Night Float
- 10 weeks of Gynecologic Oncology
- 2 five-week rotations
- 10 weeks of Maternal Fetal Medicine
- 2 five-week rotations
- 8 weeks of Gynecology Specialty Clinics
Dysplasia, office hysteroscopy, complex contraceptive clinic,
FLS/Simulation, high school wellness clinic
- 5 weeks of Female Pelvic Medicine and Reconstructive Surgery
Labor and Delivery Rotation
The PGY2 undertakes four separate 5-week rotations on Labor and Delivery throughout this year. The PGY2 resident takes the lead on managing the patients on the laboring floor, delegating to their PGY1 and consulting with their PGY4 team member. The PGY2 is responsible for managing the more medically complex patients on the Labor and Delivery unit. They are also responsible for managing the obstetrical triage area and assisting in repeat cesarean deliveries. Kaiser LAMC is a referral center for both Maternal Fetal Medicine and Nursery level of care and accepts high risk maternal and/or fetal transports from greater Southern California KP region.
Maternal Fetal Medicine Rotation
Two separate 5-week rotations on the Maternal Fetal Medicine service complement the L&D experience. During these rotations the PGY2 works closely with their PGY3 colleague and each of the Maternal Fetal Medicine Attendings (who rotate) in caring for the complex obstetrical patients on service. As a KP Southern California referral center, LAMC accepts, cares for, and delivers patients with high levels maternal or fetal complexity. Working within the team, the PGY2 presents the in-patient service at morning board rounds. The day then continues in the maternal fetal medicine outpatient clinic. There the PGY2 assists with the care of the complicated outpatient obstetrical service as well as with consultations, monitoring, follow up, and delivery planning of high-risk outpatients. During this rotation, ultrasound skills are emphasized with experience in basic biometry that progresses to level II anatomy surveys and doppler studies. There is also extensive experience with reading external fetal monitoring. The PGY2 is involved in organizing the perinatal high-risk multispecialty conference that is tasked with planning complex deliveries of at-risk mothers or pregnancies.
Gynecologic Oncology Rotation
The PGY2 spends two 5-week rotations on the Gynecologic Oncology service under the direction of two gynecologic oncologists, an oncology nurse practitioner, a gynecologic oncology fellow and a PGY4 resident. The PGY2 helps manage patients’ pre- and postoperative care, assesses patients in the emergency room, assists with chemotherapy regimens, attends specialty conferences and provides ambulatory care, all under faculty supervision.
Female Pelvic Medicine and Reconstructive Surgery Rotation
The PGY2 spends 5 weeks in the urogynecology clinic as a way to understand the importance of care in this arena. The PGY2 assists the urogynecologist in the office assessments of incontinence and prolapse issues. There is learning on pelvic floor anatomy and function. The PGY2 joins the urogynecology team in the operating room for a better understanding of the surgical approach of these problems. They may expect to be involved in the minor aspects of these surgical procedures.
Night Float Rotation
The PGY2 undertakes two 5-week night float rotations during which they mirror the Labor and Delivery PGY2 responsibilities. The PGY2 works closely with their PGY1 and PGY3 night float team to provide seamless care to the patients overnight. As with the PGY2 day rotation, they are primarily responsible for the more complex labor and delivery patients. As the year progresses, the PGY2 gets graduated experience into the emergency room for appropriate level consultations. The night float residents work from Sunday night to Thursday night and have the entire weekend off.
Gynecology Clinics Rotation
In this 8-week rotation the resident works with faculty attendings learning specialty outpatient procedures in the clinic setting. The PGY2 starts their day assisting on scheduled cesarean deliveries (3 days a week) or providing circumcision procedures (2 days a week). From there, the resident goes to one of multiple specialty clinics and works 1:1 with attending faculty providing care and expanding their proficiencies in specific office procedures. Specialty clinics include: 1) Two half days in dysplasia clinic performing colposcopy and LEEP procedures, 2) One half day doing office diagnostic and operative hysteroscopy, 3) One half day working in the simulation lab, fulfilling the EMIGS curriculum, working on technical skills and learning personal ergonomics, 4) One half day working at our community high school wellness clinic and 5) Two half days in complex contraceptive clinic (CCON) working with our family planning specialists providing contraceptive options and methods to women with complex medical conditions, performing diagnostic and elective office manual vacuum aspirations and counseling women about first and second trimester abortions. In the case of second trimester abortions, the resident will fully assess, consent and place laminaria with the goal of providing the abortion procedure the following day, and 6) One half day operating room time, primarily for medically complicated first or second trimester abortion procedures. The last half day consists of the resident’s personal continuity clinic. It is our goal that all our residents get early training in office procedures and graduate proficient enough to offer these procedures to the patients they care for.
Post Graduate Year Three
The focus of the third year of training emphasizes emergency room assessments, gynecologic surgery and research. This year includes concentrated surgical training. There is greater emphasis on teaching and leading within a team structure. Progress to completion on a chosen research project is expected by the end of this year.
- 10 weeks of Labor and Delivery/Gynecology-Night Float
- 2 five-week rotations
- 10 weeks of Benign Surgical Gynecology
- 2 five-week rotations
- 10 weeks of Minimally Invasive Surgical Gynecology-Kaiser Fontana
- 8 weeks of Maternal Fetal Medicine
- 6 weeks of Reproductive Endocrinology and Infertility
- 4 weeks of Elective
- 2 weeks Clinics
Benign Gynecology Rotation
The PGY3 resident has two 5-week benign gynecologic surgery rotations at LAMC. The PGY3 resident works with a team that includes a PGY4 and a PGY1. The PGY3 resident assists the generalist and minimally invasive gynecologic surgeons in a variety of major and minor procedures including laparoscopic, vaginal and abdominal hysterectomies, diagnostic and operative laparoscopy and diagnostic and operative hysteroscopy. Within the team, the PGY3 is the senior resident and responsible for teaching the PGY1 and the medical student, especially in the art of emergency room consultation.
Maternal Fetal Medicine Rotation
The PGY3 undertakes a 10-week rotation in maternal fetal medicine (MFM). The PGY3 leads the PGY2 in providing care to the perinatal MFM in-patient service. They are the first assist on any prescheduled high-risk obstetrical procedure undertaken on labor and delivery or in the main operating room. In the clinic, the PGY3 assists the MFM specialist in providing outpatient consultations on high-risk pregnancies, many of which are referred from throughout the Southern California KP region. The PGY3 resident undertakes competencies on more advanced ultrasound proficiencies including level II fetal anatomy surveys, focused fetal ultrasound surveillance and doppler studies. The PGY3 on the MFM rotation is responsible for participating in multidisciplinary L&D board rounds every morning as well as organizing the perinatal multispecialty conference that guides delivery plans in the setting of complicated maternal or fetal conditions.
Minimally Invasive Gynecologic Surgery Rotation-Fontana
In order to increase proficiency in minimally invasive surgery (MIS), the PGY3 undertakes a 10-week surgical rotation at the Kaiser Permanente Medical Center in Fontana. This hospital is centered in a rapidly growing area of Southern California and is designated a Minimally Invasive Gynecologic Surgery (MIGS) Center. While at Fontana, the PGY3 functions as a primary assist in minimally invasive surgeries performed by generalists and specialists alike. The PGY3 also takes L&D call thus experiencing the differences in care needed by a different population in a different environment with a high volume of deliveries. Because of the distance, GME funds room and board for this rotation.
Reproductive Endocrinology and Infertility Rotation
Third year residents rotate in the Reproductive Endocrinology and Infertility (REI) department for 4 weeks. Under the supervision of five board-certified reproductive endocrinologists, residents learn the infertility assessment and what assistance is available to those wishing to conceive. They perform office salinesonohystograms, hysterosalpingography, office hysteroscopy and intrauterine inseminations. The PGY3 receives formal teaching in transvaginal ultrasonography to assess gynecologic anatomy, evaluate for pathology and to assess follicular development. Residents scrub for all surgical procedures performed by the REI service during their rotation. In addition, there are opportunities to observe assisted reproductive technology procedures such as egg retrieval and embryo transfer done by our LAMC attendings at partnered fertility clinics in the community.
Night Float Rotation
This rotation is a total of 10 weeks, divided into two separate 5-week runs. The PGY3 is the senior OBGYN resident in-house and provides oversight to the PGY2 running the L&D floor while assisting the PGY1 with L&D experience. The PGY3 assumes the care for any critically ill patient that is admitted for labor, delivery or postpartum care. The PGY3 is first call for the in-house antenatal service as well as any in-house gynecologic oncology, urogynecology or benign gynecology patient. In particular, the PGY3 night float resident is first call for emergency room consultation. If an urgent intervention, including a surgery, is needed, the PGY3 will be involved. The night float PGY3 works closely with both the gynecology and the obstetric in-house call attendings to manage the patient care provided by the resident team. The night float team works Sunday night to Thursday night and does not do weekend call.
PGY3 Elective Rotation
This 4-week elective block is historically a research elective. However, if a resident is advanced enough in the course of their research project, they may be allowed to use this time in a multitude of educational ways. Some residents have used it for an externship experience in a field in which they have a specific interest. Other residents use it to further their educational goals in alternative approaches to care, public health or public policy. Many residents have used this four-week block to go abroad and learn about health care delivery systems in other countries or participate in a medical service trip. Any resident participating in the Global Health Track is required to undertake a global health experience during this elective. There are scholarships available to global health experience applicants. This elective provides the PGY3 an opportunity to enhance their training in a way that they feel specifically benefits them.
Post Graduate Year Four – Chief Year
The emphasis of the fourth year of training is team leading, teaching and providing quality patient care. Every chief resident leads a team of junior resident physicians and is responsible for all aspects of care rendered to the patients on their service. They administer and organize the care provided by their team and are responsible for the teaching and learning of the junior residents in their charge. Because of the night float system, the chief resident only has weekend and back up call responsibilities. Each resident is required to present their major research and quality improvement project by the end of their fourth year. It is required that this research project be of sufficient quality to submit to an appropriate society meeting. Towards the end of the year, they will present this major project in-house as well as submit it to the LAMC research forum. By chief year, many of our residents have already completed and submitted abstracts with many presenting them at respective society meetings. Our GME department supports residents invited to present their work.
- 10 weeks of Obstetrics-Labor and Delivery
- 10 weeks of Benign Surgical Gynecology
- 10 weeks of Gynecologic Oncology
- 10 weeks of Female Pelvic Medicine and Reconstructive Surgery
- 8 weeks of Minimally Invasive Surgical Gynecology – Kaiser West Los Angeles
- 2 weeks of Clinic Procedures
Benign Gynecology Rotation
PGY-4 residents lead a 10-week rotation on the benign gynecology service. This rotation is primarily a surgical rotation, but this team is also responsible for emergency room assessments and care for all inpatient gynecology patients. The chief resident of this team is in charge of managing the care rendered by their team. The chief resident is responsible for teaching and supervising their PGY-3, PGY-1 and medical student team. The PGY4 works closely with our gynecology mentor faculty that lead a weekly half day of clinical teaching concentrating on surgical case review and the evidence-based approach to consultation and treatment and procedural or surgical approach of the patient with gynecologic conditions. The PGY4 is expected to review and appropriately assign the surgical cases to be presented and to assist the gynecology attending in the teaching points of each case.
Minimally Invasive Gynecology Surgery Rotation-West Los Angeles
Chief residents enjoy an 8-week minimally invasive surgical (MIS) rotation at the Kaiser Permanente West Los Angeles Medical Center (WLA). The WLA Medical Center is a designated Minimally Invasive Gynecology Surgical (MIGS) Center with 95% of all gynecologic surgeries performed there deemed minimally invasive. As the sole resident, the PGY4 is the primary assist on most major surgeries and is responsible for perioperative care. The resident first assists with generalists who have a special interest in MIS surgery, a gynecologic oncologist, two fellowship trained Female Pelvic Medicine/Reconstructive Surgeons and two MIS trained OBGYNs on staff. While at WLA, they work with an entirely different patient population with particular social determinants of health. The PGY4 takes L&D call once a week, affording them an opportunity to see how a different medical center runs their L&D suite.
Chief Labor and Delivery Rotation
The PGY4 resident on labor and delivery is responsible for the management of the in-patient obstetrical service. This includes normal and complicated laboring patients, antepartum patients, high-risk maternal fetal medicine patients and postpartum patients. Under the guidance of the maternal fetal medicine attendings, the chief resident is charged with organizing and undertaking any diagnostic, treatment and delivery procedures needed by hospitalized antenatal MFM patients. The PGY4 works closely with the obstetrician and the certified nurse midwife on call, to manage the care of all patients that are presenting to L&D triage, are laboring, or are on the postpartum floor. The chief resident is responsible for the PGY2, PGY1 and medical student on their day team as well as the PGY3, PGY2 and PGY1 on their night team. They must be aware of all care rendered, assure appropriate understanding of the care plan and procedures by their junior residents, personally care for the most acutely ill patients, manage all complications and assure the general flow of the Labor and Delivery and Postpartum Floor.
Chief Gynecologic Oncology Service
The PGY4 on the gynecologic oncology service works closely with the gynecologic oncology attendings, the gynecologic oncology fellow, the PGY2 and the medical student sub-intern on the team in order to provide care to all the patients in-house, be it post-operative or admitted for further oncologic care. The PGY4 has opportunities to assist with major gynecologic oncology surgeries with the fellow or with the gynecologic oncology attending. They round with the team and are charged with assuring a good understanding of the plan of care with their PGY2 resident. The PGY4 coordinates the day-to-day clinical activities of the service, assists with new consultations and provides postoperative care for returning patients. They are also involved with care for patients receiving radiation and chemotherapy. The PGY4 is responsible for coordinating and conducting the weekly “tumor board” that reviews surgical pathology and recommended next steps in treatment for their oncologic patients.
Chief Female Pelvic Medicine and Reconstructive Surgery Rotation
During this 10-week rotation, the chief resident on service works closely with all three of our board certified Female Pelvic Medicine and Reconstructive Surgeons in providing evaluations and consultations in the urogynecology specialty clinic. They assist in performing indicated urogynecologic surgical procedures. The focus of the rotation includes both the office assessment and subsequent surgical treatment of urinary incontinence and pelvic organ prolapse including vaginal hysterectomy. The senior resident either performs or assists during all cases and is responsible for post-operative care and follow-up.
Continuity clinics are scheduled weekly depending on the resident’s rotation. Initially, interns and attending physicians see patients together. The intern graduates to independence depending on the patient case and the intern’s aptitude. There is always a Staff/Faculty Clinic Mentor present in the resident clinic who supervises and assists with clinical reasoning and problem solving, ultrasounds or procedures necessary during individual patient appointments. There is a resident work room, examination rooms and nursing staff dedicated to resident clinics. The residents have support from a dedicated nurse who helps facilitate follow up appointments for resident patients from hospital, operating room or emergency room discharge.
Because we believe it is important to be confident and competent in providing gynecologic office procedures, we have integrated a Gynecology Ambulatory Clinics rotation into the PGY2 curriculum. During this rotation there is 1:1 teaching and mentoring in specific clinic procedures and specialty clinics. Included are two half days in dysplasia clinic (office colposcopy, cervical/vaginal/vulvar biopsy, LEEP), two half days in complex contraceptive clinic (medically complex contraception consultations, office manual vacuum aspiration, preoperative evaluations for D&Es, laminaria placement), one half day off-site staffing our high school wellness clinic (providing STI screening, LARC to adolescent patients and their families), one half day performing office hysteroscopy and one half day concentrating on FLS and undergoing personal evaluation and training in our simulation laboratory. Our goal is that you will become competent with gynecologic office procedures early in your training in order to more seamlessly integrate them into your everyday clinical practice.
In the fourth year we have embedded a two-week outpatient clinic procedure rotation. We have found that this concentrated time is useful for helping the resident reorient to office procedures and increase their own efficiencies in preparation for independent practice.
Simulation and Essentials of Minimally Invasive Gynecologic Surgery
We maintain a robust simulation series that provides for learning about and practicing procedures prior to providing them to patients. There is at least one simulation event during ET scheduled on a monthly basis. We concentrate on gynecologic procedures from the very basic (i.e., endometrial biopsy, IUD placement, manual vacuum aspiration) to the more complex (i.e., hysterectomy, pelvic side wall dissection, laparoscopic vascular injuries). Most of our simulations are staged with the exact instruments that would be used in our realistic operating room in our new simulation center.
We are transitioning from Fundamentals of Laparoscopic Surgery (FLS) curriculum to Essentials in Minimally Invasive Surgery (EMIGS). We provide protected time and instruction for EMIGS in the second year of residency. During the PGY2 clinics rotation, there is one half day a week dedicated to 1:1 time with one of our fellowship trained MIS to review the full EMIGS curriculum and practice the EMIGS skill set. During this time, particular needs for handedness and ergonomics are also addressed. It is expected that you will schedule and pass your EMIGS exam in second year. This helps create a strong base for translating these skills into the operating room early in your residency training.
All our residents participate in Obstetrical Critical Events Training (CETT) which concentrates on learning and practicing skills needed to approach acute situations on labor and delivery. This is a long-standing program that sequentially includes all health care providers who rotate through labor and delivery. The resident will undergo CETT along with attending OBGYNs, CNMs, Anesthesia attendings, NICU staff, L&D nursing and operating room staff and will practice simulation events such as eclamptic seizure, postpartum hemorrhage, shoulder dystocia, acute hypertensive events, pulmonary emboli, cardiovascular events, fetal intolerance to labor and code-cesarean.
Procedural and Operating Room Skills
We emphasize proficiency in outpatient procedures as well as operative skills. In the first year we begin training our interns with primary cesarean sections during their L&D rotations. During gynecology-based rotations our interns undertake MVAs, D&Cs, diagnostic and operative hysteroscopies in the operating room. In the second year we concentrate on competencies in office procedures during the Clinics Rotation as well as with more complicated first trimester and second trimester abortion procedures. In the third year, the night float resident covers all emergency room procedures and takes patients to the OR for emergent cases. During the benign gynecology rotation based at KP LAMC the third year is generally assigned as first assist to an assortment of major and minor cases in the operating room. The third-year resident also goes to a concentrated 10-week MIS rotation at the Kaiser Permanente medical center in Fontana. In fourth year, the chief resident leads a 10-week rotation on benign gynecology, 10 weeks on gynecologic oncology, 10 weeks on urogynecology and 8 weeks in concentrated MIS at the Kaiser Permanente West Los Angeles medical center.
Department and Rotation Specific Educational Activities
There is a full breadth of scheduled department conferences as well as rotation specific educational activities that occur on a regular basis. Within each rotation there is dedicated time for teaching and learning. The residents on service are not only required to attend these learning activities, but they are often integral to the way they are run. In benign gynecology there is a weekly surgical case review on Monday afternoons. The first Monday of the month includes focused pediatric/adolescent gynecology teaching. In Female Pelvic Medicine and Reconstructive Surgery there is a weekly Thursday morning lecture on pelvic anatomy and relevant topics. In Maternal Fetal Medicine there is a Multidisciplinary Perinatal Conference (MFM, Anesthesia, Pediatric/Adult Cardiology, Neonatology, Social Work and more) that brings together the individual disciplines needed for the maternal-fetal issues at hand. Gynecologic Oncology runs their “tumor board” reviewing surgical pathology, determining surgical staging and discussing recommended subsequent treatments for their oncology patients.
Thursday afternoons are designated “Educational Time” (ET) for both the residents and faculty. During this ET time we rotate through a series of educational activities that include:
rotate through a series of educational activities that include:
- Case Management Conference
- “Interesting Case” presentations
- Journal Club
- Fetal Tracing Conference
- OBGYN Ultrasound Series
- OBGYN/Radiology Conference
- Quality Assessment and Improvement Conference
In addition, we host internal and external speakers as well as attend Medical Center wide Grand Rounds. We reserve the first Thursday ET of each month to run a simulation series that encompasses teaching in simple and complex OBGYN procedures.
Outside of Thursday Educational Time, we maintain a weekly CREOG (Council on Resident Education in Obstetrics and Gynecology) based lecture series. Organizing this time is the responsibility of the academic chief resident. It varies yearly depending on the identified needs of the group as well as those of the academic chief resident. This year, the resident group organized the “top 40 ACOG bulletins that every resident should know”. These were paired with a significant, or landmark, article for a one-hour review led by a faculty member. When the national CREOG exam approaches, didactic time is used by our subspecialists for concentrated topic teaching and review. In addition to this, we maintain access to a large internet-based question bank so that residents may quiz themselves on CREOG style questions and self-evaluate for areas needing strengthening.
Research and Quality Improvement
Required for graduation from our OBGYN residency program is at least one research project and one quality improvement project. Our goal is that each resident will have a defined research project by the end of the second year. This enables appropriate time for completing a meaningful project and allows for flexibility within the third-year
elective rotation. The research project must be of sufficient quality to be submitted as an abstract for presentation at an appropriate society meeting. This research project must also be submitted to the LAMC Research Symposium in the fourth year of residency. Many of our resident research projects are ultimately submitted and accepted for publication. There is GME support for any resident who attains an invitation to present their research project at a society meeting.
Another popular resident activity is creating surgical videos. Because we are a referral center, we have multiple opportunities to be involved in unique clinical cases that involve equally unique surgical approaches. Our residents take full advantage of such situations by taping and editing educational videos that often are submitted and accepted for presentation at various society meetings.
LAMC houses a hospital wide resident wellness group that liaisons with individual residencies as well as with the house staff leadership group. Throughout the year we provide:
Resident retreat: early in the academic year, 36 hours of team bonding
- Faculty mentor: embedded mentor-mentee activities
- Personal Care Time: time off to get personal care appointments 3 times a year.
- Resident of the month: coffee gift cards
- Holiday book gift: faculty sponsored
- ACOG lobby day: faculty supported
- ACOG wellness week activities: as a department
- Congressional Leadership Congress: faculty supported
- Hospital Gym: open 24hrs, work out when you get a chance
- New resident work room: a space to take a deep breath
We end each year with a faculty and GME sponsored celebration. It is our opportunity to say goodbyes to our graduating class while welcoming our incoming class. It is a time away from the hospital to be together and celebrate individual personal journeys and a commitment to our OBGYN community.
What happens after residency?
Kaiser Permanente provides support for job search within the system. A KP recruiter meets with all our residents and discusses the options both inside and outside of KP. Application to KP medical centers in other regions (Oregon, Washington, Colorado, Hawaii, Georgia) is facilitated through this recruiter.
But not all of our graduating residents stay with Kaiser Permanente. In the last ten years, 45% of our graduating residents have found employment within the Kaiser Permanente System. Thirty-four percent were accepted to Fellowships around the country and 21% went on to work in private practice. Below are the statistics for the last 6 years:
|Kaiser Permanente||Fellowship||Private Practice|
|13 (45%)||10 (34%)||6 (21%)|
|So. CA – West Los Angeles||Pediatric/Adolescent Gynecology Baylor Univ, TX||Everett Clinic, Seattle, WA|
|So. CA – Panorama City||Women’s Care Eugene, OR|
|So. CA – Los Angeles||MFM-UC San Francisco||Planned Parenthood Los Angeles|
|So. CA – Fontana||Complex FP-U Pennsylvania||Nebraska Regional West, NB|
|So. CA – South Bay||Pelvic Surgery -Seattle Swedish||Little Company of Mary, CA|
|So. CA – Woodland Hills||REI-U Oklahoma||Geisinger System, PA|
|So. CA – Antelope Valley||FPMRS-USC|
|No. CA – Redwood City||MFM-UCI|
|No. CA – San Rafael||Gyn Onc-MD Anderson|
|No. CA – San Leandro||MIS- Virginia Mason|
|No. CA – Sacramento||OB Palliative-Scripps/UCSD|
|KP – Oregon|
|KP – Washington|
It is our goal to graduate well rounded, highly competent obstetrician and gynecologists that can begin generalist practice upon completion of this program. For those residents that choose to continue specialty fellowship training they can be sure they will be doing so with a strong foundation in generalist knowledge. For those residents who choose to embark on a generalist career, they will do so with well-developed self-directed learning and leadership skills that will continue a lifetime of learning with provision of evidence-based compassionate care to the women they serve. Just as important, our graduating residents will join our outstanding alumni family and always be a part of our community.