Integrated Obstetrics and Gynecology Residency Program Overview

The Wright State University Affiliated Hospitals Integrated Obstetrics and Gynecology Residency Program is based at Miami Valley Hospital with rotations to the USAF Medical Center, Wright-Patterson Air Force Base. Miami Valley Hospital is an 827-bed, state-of-the-art tertiary referral hospital, and has the only tertiary maternity/neonatal care facility in a 17-county area of Southwest Ohio. The USAF Medical Center, Wright-Patterson, is a 350-bed hospital and is one of the largest Air Force teaching and referral hospitals in the United States.

The chair, program director, associate program directors, faculty, program coordinator, affiliated hospitals and clinic disciplines are actively involved in the educational program. The program is currently approved to train six residents per year for a total of 24 residents. Three of the residents in each program year are military and are chosen through the Military Selection Board. The three civilian residents are selected through the National Resident Matching Program.

The first year provides rotations in internal medicine, outpatient gynecology, ultrasound, obstetrics and family medicine, along with one half-day primary care clinic per week. Succeeding years provide rotations through urogynecology, oncology and endocrinology, as well as progressive obstetrical and gynecological experiences.

Didactic conferences by the full-time and clinical faculty are held in high-risk obstetrics, genetics, ultrasound, pathology, perinatology, endocrinology and gynecologic oncology. Additional conferences include gynecologic pre-op conferences, fetal monitor strip reviews and tumor conferences, as well as peer review presentations and quarterly journal club conferences. A weekly Ob/Gyn Grand Rounds schedule utilizes visiting speaker presentations on a wide range of topics. All residents take the annual CREOG in-service training examination.

The progressive education of the resident is integrated with the participant's clinical experience, utilizing patient clinics, supervised surgery, daily teaching rounds and combined staff rounds. In-depth experience is provided in high-risk obstetrics, ultrasound with both abdominal and vaginal probe exposure, endocrine infertility, laparoscopy, minimally invasive surgical techniques, pelviscopy, microsurgery, coloscopy, general and radical surgery, laser applications with both intra-abdominal and external and gynecologic urology.

The faculty incorporates the Accreditation Council for Graduate Medical Education (ACGME) six competencies into all of their teaching and instruction so that the residents may demonstrate the following: 1) Patient Care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health; 2) Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as, the application of this knowledge to patient care; 3) Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care; 4) Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and other health professionals; 5) Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds; and 6) System-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as, the ability to call effectively on other resources in the system to provide optimal health care.

Progressive skills are monitored by a resident experience recognition program. These recognitions are granted to each resident upon satisfactory documentation and performance of techniques, skills and decision-making in his/her training rotations. Chief residents directly manage their respective services with access to full-time and clinical faculty for supervision, consultation and conferences. The progression of the program is balanced and non-pyramidal.

Divisions

General Obstetrics and Gynecology

The Division of General Obstetrics and Gynecology provides an active clinical teaching program at the two affiliated institutions. Board-certified faculty members are responsible for providing general obstetrics and gynecologic teaching and supervision for residents and students.

Outpatient clinics and surgical procedures, tubal and postpartum sterilizations, colposcopy, pelviscopy procedures, and laser surgery provide the residents the hands-on experience needed to hone their techniques and surgical skills. Pelvic reconstructive surgery and urogynecology are special techniques also incorporated into the educational program.

Maternal-Fetal Medicine

The Division of Maternal-Fetal Medicine includes board-certified faculty who develop and enforce all obstetrics protocols for the MVH Perinatal Health Center, as well as the obstetrics standards for obstetrical services at the USAF Medical Center, Wright-Patterson (in conjunction with the U.S. Air Force Operating Instructions). Residents and students are taught all aspects of obstetrical care: high-risk obstetrics patient care, labor and delivery, postpartum care, consultation service and research.

The division is a referral base for complicated, high-risk obstetrical patients, and for its expertise in perinatal ultrasound diagnostic testing. Fetal heart rate monitoring, antepartum testing, biophysical profiles, amniocenteses, CVA, cordocentesis, Doppler flow studies and other ultrasound studies are performed on high-risk pregnancy patients.

Gynecologic Oncology

The Division of Gynecologic Oncology includes board-certified faculty who exhibit subspecialty credentials. These faculty members are responsible for providing gynecologic oncology teaching to the residents and medical students. They offer daily clinical teaching rounds, pre-op rounds and weekly tumor boards (attended by residents, students, nurses, and other medical support personnel). This division supports a heavy clinical practice and is actively involved in numerous research protocols and studies.

Reproductive Endocrinology

The Division of Reproductive Endocrinology and Infertility consists of board-certified faculty who are responsible for training residents and students in reproductive endocrinology and infertility, including all advanced pelviscopy procedures, laser, hysteroscopy, and microsurgery. Infertility therapy also includes ovulation induction with Clomid or Pergonal, intrauterine inseminations, and/or testing the male factor in infertility.

Research

The department of obstetrics and gynecology has active research efforts in obstetrics, gynecology, gynecologic oncology, maternal-fetal medicine and endocrine infertility. The department has recently established a reproductive research laboratory and continues to expand its research efforts.

Residents actively participate in research projects and are required to complete at least one project in their senior year. In addition to presentations at regional and national meetings, research papers are presented annually during the spring research seminar.

Program Facilities

Miami Valley Hospital

Miami Valley Hospital (MVH) is an 848-bed community hospital and a principal teaching affiliate of Wright State University Boonshoft School of Medicine. The hospital was founded in 1890 by Reverend Carl Mueller of the German-Lutheran Church. MVH is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). With a staff of more than 1,200 physicians representing 34 primary, medical and surgical specialties, MVH ranks in size among the nation's top 100 hospitals.

Miami Valley Hospital's regional services include a high-risk maternity center serving 17 counties; a Neonatal Intensive Care Unit--Dayton's only ECMO and with our family-centered maternity program; a comprehensive reproductive Center; Dayton's only Level I Emergency and Trauma Center; CareFlight, the area's air ambulance service; the Regional Adult Burn Center; and the Regional Chronic Kidney Dialysis Center. Other services offered include a senior program, health information center, cardiovascular laboratory and intensive care unit, medical/surgical intensive care unit with an expanded advanced care unit, cancer treatment and research, alcohol and chemical dependency unit, sports medicine and physical rehabilitation, and a neuroscience center, which offers diagnosis and treatment for hearing and balance disorders, chronic pain and sleep disorders.

MVH nurses and other health professionals care for patients at the bedside, and work closely with physicians and residents to develop and implement individualized care programs.

The MVH Craig Memorial Medical Library is one of the largest of its kind in Ohio. It has more than 30,600 bound volumes, monographs and 600 journal subscriptions. Additional material through interlibrary loan and computerized, bibliographic searching tools are available to physicians and residents. Shared services with all the Dayton hospital libraries and WSU School of Medicine Fordham Health Sciences Library are maintained via the OhioLINK computer system.

The Berry Women's Health Pavilion offers the most comprehensive maternity service available in a 17-county area. The Pavilion and Maternity Building contain the following units:

Birthing Center 2 -- Labor & Delivery provides care to mothers of all risk categories and infants in low risk categories. L&D incorporates perinatal care including: antepartum, intrapartum, neonatal and postpartum services. All patients, unless a scheduled admission (i.e. induction of labor or Cesarean) with anticipated ongoing pregnancies are seen in the assigned triage area for numerous chief complaints (i.e. rule out labor and/or ruptured membranes, antepartum testing, evaluation of vaginal bleeding, monitoring blood pressure, lab testing). Patients are initially seen in one of the nine triage rooms, prior to being admitted, transferred or discharged, based on assessment. Newborns are assessed at birth and are transitionalized at the bedside or in the Transitional Nursery.

Medical and nursing staff assess the patients’ needs. Care is determined based on the physical, social and historical data as well as other diagnostic data and patient preference. All patients are assessed by an RN upon arrival. Since we are a Level III Center, patients and referring agencies have access to maternal-fetal, neonatal physicians and anesthesia services 24 hours a day, seven days a week. In addition, through our affiliation with Wright State University School of Medicine, there is in-house resident and attending coverage 24 hours a day.

Maternity 1, Birthing Center 1 and Newborn Nurseries -- M1 and BC1 are each inpatient units that care for postpartum vaginally-delivered, post-operative Cesarean and tubal ligation patients, and healthy newborns. Maternity 1 provides capacity for 22 mothers and 22 babies. BC1 has capacity for 18 mothers and 12 babies. Services provided include nursing care during recovery from birth, infant care, care coordination and discharge instructions. Length of stay varies according to patient condition, with an average of 2.3 days for vaginal deliveries, 3.6 days for Cesareans and 2.2 days for newborns. Average daily census is 12 mothers and 12 babies per floor.

Maternity 2 and Newborn Nursery -- M2 is a 16-bed inpatient unit that cares for antepartum patients with medical, surgical or obstetrical complications; postpartum Cesarean and vaginally-delivered patients; healthy newborns; and postoperative gynecological patients. Patient ages range from newborn, to women from menarche to menopause.

Family Beginnings Birth Center -- FBBC is a wellness model of care for low-risk women and their families, providing non-interventional childbearing care. Services provided include care coordination, educational classes, nursing care during labor, birth and recovery, and infant care.

Neonatal Intensive Care -- NICU is a Level III inpatient unit that cares for healthy neonates from birth through the transitional period, and those neonates with a variety of medical and surgical conditions. The patients’ ages range from the neonate at birth (encompassing all stages of prematurity to term) up to 28 days of age, and infants beyond the neonatal period but less than one year of age.
The NICU provides 24-hour, 7-days-per-week comprehensive care through a multidisciplinary team approach. Care of the patient is based upon physical, developmental, social and historical data, as well as other diagnostic and family preferences. There are 59 beds located in the Berry Women’s Health Pavilion. The unit is divided into the following areas: the 33-bed NICU is located on the second floor; a 10-bed Neonatal Special Care Unit and a 16-bed Developmental Graduate Nursery is located on the first floor; and a Transitional Nursery is situated on the second floor in the maternity area. Admission to the nurseries is determined by physician-developed criteria.

Diagnostic and consultative services are readily available. The NICU provides care for patients with a variety of medical diagnoses and surgical conditions. Extracorporeal Membrane Oxygenation (ECMO) is available on site. A collaborative relationship exists between Miami Valley Hospital and the Children’s Medical Center of Dayton for specialty coverage and transport. Home care service is contractually provided through an agreement with Fidelity Home Care.

Center for Women’s Healthcare -- The CWHC provides outpatient services for obstetrical and gynecological care to patients from the age of 10 through the lifespan. Patient needs are assessed by a registered nurse, nurse practitioner, certified nurse midwife, resident and/or attending physician. Appropriate diagnostic services are available based on the physical or historical data collected. Social services and nutritional counseling are available to all patients. Childbirth classes are taught in English and Spanish. Teens may attend the Teens Learning and Caring (TLC) childbirth preparation classes.

Birth and Family Education -- The BFE department consists of an all RN staff who provide a wide variety of education and support to childbearing women, their families and support systems in the classroom setting or in the inpatient antepartum setting. Certified lactation consultants provide lactation education and support to women (and their families and support systems) who intend to breastfeed or provide human milk to their infants. Postpartum follow-up is provided as needed with phone consults or lactation clinic visits. Other in-patients with medical care needs who are lactating also are seen for consults by the lactation consultants.

Diagnostic Ultrasound and Antenatal Testing -- The unit primarily provides antenatal services for diagnostic testing of uncomplicated and high-risk pregnancies. These services include obstetric and gynecologic ultrasound, neonatal ultrasound of the head and abdomen, antepartum testing, genetic counseling and preconception counseling. The clinical staff consists of board-certified perinatologists, American registered diagnostic medical sonographers, registered nurses, board-certified genetic counselors, and dieticians. Care is provided in a coordinated, multidisciplinary team approach. There is emphasis on patient education and choice of treatment options. Services are provided Monday through Friday with U/S and medical staff available after hours on an on-call basis.

USAF Medical Center, Wright-Patterson Air Force Base

The U.S. Air Force Medical Center is located northeast of Dayton on Wright-Patterson Air Force Base (WPAFB) and offers a rich, educational history linked closely to the city of Dayton, the "Birthplace of Aviation" and the home of Wilbur and Orville Wright. It is one of six Air Force medical centers throughout the world and acts as a referral hub for military bases throughout the Northeast and Midwest regions of the country.

The USAF Medical Center maintains accredited programs in internal medicine, surgery, obstetrics and gynecology, pediatrics, psychiatry, clinical psychology and dentistry. All faculty members are board certified or active candidates for certification and maintain an active interest in research.