Residents rotate on the obstetric service at Cooper University Hospital for three months each in PGYs 1, 2 and 4. Additional exposure to obstetrics occurs on the night float rotation for three months during PGYs 1 and 2, two months during PGY 3, and one month during PGY 4. Resident experience on the obstetric and night float rotations involves evaluation and management of all patients presenting to Labor and Delivery. Their exposure includes, but is not limited to, triage, labor and delivery, and postpartum. There are approximately 2,200-2,500 deliveries and approximately 4,000-5,000 triage visits annually at Cooper University Hospital. Approximately 25% of the deliveries performed at Cooper are from the residents' Continuity of Care Clinic. Additionally, year-long exposure to obstetrics takes place at the Women’s Care Center, where each resident provides weekly continuity outpatient prenatal care.
Teaching rounds with the residents and faculty occur daily on the obstetric service. There is also multi-disciplinary board sign out which occurs daily at 9:00 involving the obstetrical faculty and residents, anesthesiology team, Labor and Delivery nurses and managers, NICU team, and social work. This facilitates situational awareness, patient safety, and education. Additionally, there is a fetal heart tracing review every Tuesday morning involving the obstetrical faculty and residents along with nursing staff to facilitate educational discussion and enhance communication.
Residents receive extensive experience in operative gynecology at Cooper. Residents rotate on the Cooper gynecology service for two months during PGY 1-3, and three months during PGY 4. Currently, PGYs 2, 3, and 4 on the night float rotations perform additional operative gynecology at Cooper. The residents participate in all surgical procedures as either the primary surgeon or the assistant, depending upon the complexity of the case and their level of training.
First year residents also spend an additional month at the Cooper Surgical Center in Voorhees, NJ, performing minor gynecologic procedures with faculty. This provides residents with early exposure and repetition of some of the most common gynecologic procedures.
The gynecologic experience involves preoperative evaluation, conducted on both an emergency basis and through the weekly Preadmission Testing (PAT) and Colposcopy Clinics. Also, the residents perform outpatient procedures such as LEEP, hysteroscopy, and cryotherapy in the Women’s Care Center. Last year, this experience totaled approximately 1,875 major and minor operative procedures. In addition to participating fully in faculty and attending cases, the residents have weekly OR block time for cases generated from the resident PAT and Colposcopy Clinics.
Teaching of operative gynecology occurs on many levels at Cooper University Hospital. Each morning, the gynecology team makes teaching rounds on every postoperative patient with assigned rotating faculty. Additionally, individual teaching occurs intraoperatively, appropriate to the resident's level of training, with topics generally covering anatomy, preoperative evaluation and operative management.
Residents rotate on Night Float for 3 months in both PGY1 and 2, two months in PGY3, and 1 month in PGY4. The night float team consists of three residents during any given month, including one first year resident, one second year resident, and one senior resident (PGY3 or 4). The night float team is supervised by an in house attending at all times. Residents on night float are responsible for covering Labor and Delivery, triage, postpartum, antepartum, as well as the GYN and GYN ONCOLOGY services in addition to any ER consults that occur overnight. This rotation gives residents an opportunity to manage labor and delivery and participate in emergency surgeries including but not limited to ectopic pregnancies and incomplete abortions.
Maternal Fetal Medicine
The resident gains experience in high-risk obstetrics during rotations in Maternal Fetal Medicine (two months in PGY 3 and one month in PGY 4). They also gain experience in high-risk obstetrics during rotations in obstetrics at Cooper University Hospital, since more than 50% of the admissions to Cooper’s Obstetrical Units are high risk. As a Regional Perinatal Center, Cooper University Hospital receives the majority of the maternal transports from the entire Southern New Jersey region. While on the MFM Service, the resident is exposed to the management of high-risk inpatients in the Maternal Fetal Care Unit (MFCU), Maternal Advanced Care Unit (MACU), as well as outpatients in the weekly High Risk Clinic at Women’s Care Center. The resident is also exposed to high-resolution fetal ultrasound, including 3-D and 4-D ultrasound, vaginal ultrasound and antepartum fetal assessment, including amniocentesis, CVS and PUBS, in the Antepartum Diagnostic Center.
There are daily attending rounds with a board-certified Maternal Fetal Medicine attending. These teaching rounds stimulate the discussion of interesting cases and review the management plans developed by the resident. There is also a High Risk Conference after each High Risk Clinic run by an MFM attending, where a multidisciplinary team discusses the management of patients and interesting MFM topics.
Cooper University Hospital has the largest Gynecologic Oncology service in the Delaware Valley and is part of MD Anderson Cancer Center. This rotation provides residents with extensive exposure to gynecologic malignancies. PGY 3 residents rotate for two months per year, while PGY 1, 2 and 4 residents spend one month on the Gynecologic Oncology service. The Cooper residents function as chief of the service and oversee and manage a team composed of rotating OB-GYN residents from neighboring institutions and medical students. Residents are exposed to all aspects of care provided for those with gynecologic malignancies. These range from preoperative evaluation, operative and post-operative management, to administration of chemotherapy and associated complications. The rotation also includes weekly outpatient experience at the MD Anderson Cancer Center with gynecologic oncology faculty.
Resident teaching about gynecologic malignancies is vast and multidisciplinary in nature. Operative cases and attending rounds provide opportunity for daily teaching on current clinical topics. A weekly conference, with attendance by all the Gynecologic Oncology faculty and faculty representatives from the Department of Pathology, focuses on the pertinent pathology and clinical management of all current inpatients with gynecologic malignancies. The Gynecologic Oncology Division has an AOA accredited three-year fellowship.
Female Pelvic Medicine and Reconstructive Surgery
The Division of Female Pelvic Medicine and Reconstructive Surgery provide the residents with experience in urinary incontinence and pelvic floor dysfunction. This experience is enhanced by the presence of an approved three-year fellowship in Urogynecology at Cooper University Hospital. PGY 3 and 4 residents each rotate exclusively for one month per year on service, and are exposed to the full complement of services related to the assessment and treatment of incontinence and pelvic floor dysfunction. The residents rotating on the Gynecology service gain operative, postoperative and outpatient urogynecology experience during the months when there is no assigned resident on service.
A weekly Urogynecology clinic in the Women’s Care Center, and resident participation in sessions at the private attending office, provides ample opportunity for office evaluations and detailed urodynamic testing.
The formation of the fellowship in Female Pelvic Medicine and Reconstructive Surgery has greatly enhanced the academic experience for the residents. The Division holds a monthly journal club, which provides a forum for the discussion of current literature related to the study of incontinence and pelvic floor dysfunction. On a daily basis, the residents engage in clinical teaching rounds with the fellows and attending staff. Both the fellows and attendings are active participants in grand rounds and resident didactic sessions, providing formal lectures on a wide array of urogynecology topics.
Reproductive Endocrinology and Infertility/Family Planning
The resident splits time between Reproductive Endocrinology and Infertility as well as Family Planning through split one-month rotations in PGY 3 and 4. The rotation is designed to expose the resident to both outpatient management and inpatient care. For the REI portion of the rotation, the resident attends office hours with members of the Division of Reproductive Endocrinology. The resident also participates in the various stages of in vitro fertilization. The resident participates in egg retrieval, embryo transfer, and sperm analysis in the andrology lab at the Cooper Institute for Reproductive and Hormonal Disorders. The resident has opportunity to perform many transvaginal ultrasounds for follicle evaluation and early pregnancy diagnosis. The resident performs and interprets hysterosalpingograms and sonohystograms with the REI attending. The resident scrubs on all REI surgical cases with the attending, and rounds with the attending on all postoperative patients. Resident teaching occurs during rounds and in the office when the resident has one-on-one time with the reproductive endocrinologist in addition to intra-operatively.
For the Family Planning portion of the rotation, the resident participates in a Family Planning clinic session at the Women's Care Center (resident clinic) alongside a fellowship trained physician. During this clinic session, the resident is able to gain experience in contraceptive counseling particularly to high risk patients, placement of IUDs and Nexplanon, and family planning counseling including abortion services. Residents also participate in pre-operative management for terminations, including pre-admission testing and laminaria placement. The resident also performs surgical cases both at Cooper Hospital as well as at Cherry Hill Women's Center; surgical cases include sterilization as well as first and second trimester D&Es.
The residents are exposed to basic medical epidemiology and statistics throughout their four-year experience at Cooper University Hospital. The weekly Grand Rounds lecture series host speakers from diverse academic backgrounds that present epidemiologic designs and utilize medical statistics to address challenging clinical topics. As part of the ACGME Housestaff Lecture Schedule, residents receive lectures on research design and statistics. The monthly journal clubs provide opportunity to teach medical epidemiology and statistics in a more interactive manner. During weekly didactics, the residents are lectured in epidemiology and statistics by research-minded faculty. In addition, medical library representatives lead an interactive discussion and navigation of evidence-based resources, including the Cochrane database and the American College of Physicians Journal. During PGY 2, residents also have a one month rotation dedicated strictly to their research project which is a good opportunity for them to submit their proposal to the IRB and/or have dedicated time for data collection.
Participation in research is a mandatory program requirement that must be completed with a paper suitable for publication. This research project is to be performed with guidance from a Cooper faculty advisor, and formally presented to the department and guest faculty during the third year of residency. Subsequently, it is expected that the resident submit their research for participation in the Cooper University Hospital resident research poster competition and to the Obstetrical Society of Philadelphia for the S. Leon Israel Award. The residents’ projects have been received quite favorably, placing in the Cooper University Hospital Poster Competition and in the Cooper Resident Research contest. Several of our residents have also gone on to present their research at outside conferences and have had their research accepted for publication.
Each resident is assigned a continuity of care clinic upon entering the residency program, which is maintained until graduation. The continuity clinic is one half-day session a week at the Women's Care Center (WCC). There are approximately 9,600 outpatient visits per year at the WCC. It is only during the elective rotation in the third year that the residents are not scheduled for a continuity of care clinic. During all other rotations, whether in or out of the department, the resident returns to cover his/her clinic. Additionally, in PGY 1 and 3, each resident has an additional dedicated month of outpatient clinic only. This enables the resident to become more comfortable in the outpatient setting and further continuity with their patients.
The patient population is predominantly African American (51%) and Hispanic (31%), with some Caucasian (13%) and Vietnamese (5%) women. The resident’s continuity of care clinic incorporates all aspects of primary OB-GYN care including annual gynecology exams, normal obstetrical care, postpartum evaluation and gynecologic problems. The residents see these patients for initial evaluation and follow with them for all of their subsequent visits. When residents identify patients in their continuity clinics with more complicated pregnancies, endocrine disorders and pre-malignant and malignant gynecologic problems, they can refer these patients to the appropriate resident specialty clinics for care.
There is a dedicated faculty attending assigned to cover each clinic. Each patient is reviewed with the attending, giving the resident the opportunity for one-on-one learning. The attending physician has no other responsibilities during this assignment and is fully available to supervise, guide and teach the residents in the care of their patients. At the discretion of the supervising attending, increasing responsibility for patient care is given to the resident. There is also support staff available at the clinic for patients including social work, dietitian, and nursing.
During PGY 3, residents have an elective month. This rotation is designed to allow the resident autonomy in developing their skills and experience in the area of their choosing. Some residents have taken this opportunity to rotate within a sub-specialty at another facility, particularly if they are interested in pursuing fellowship training after graduation. Others have used this opportunity to get additional experience at the surgical center or accomplish more with their research. Several residents have also used this opportunity to be part of international medical missions such as Ghana and Jamaica.
During PGY 4, residents rotate for one month at the MD Anderson Cancer Center with faculty from various areas of the breast clinic including breast surgeons, hematologist-oncologists, radiologists, and genetic counselors. On this rotation they gain experience in understanding breast cancer genetics and screening, interpreting breast imaging studies, performing breast exams, and assisting in breast surgeries.