Overview

The Obstetrics & Gynecology Residency Program at Maimonides Medical Center is a fully accredited four-year residency program that is integrated with Coney Island Hospital. The program has a total of 20 residents, with five residents at each level and a teaching staff of 20 faculty physicians, including individuals certified in all subspecialties, 40 voluntary attending physicians, 20 certified midwives, and seven full-time physician assistants. Coney Island Hospital has eight full-time and four part-time faculty physicians who are involved in the teaching program. Seventy percent of the residency training occurs at Maimonides Medical Center and the remaining 30% at Coney Island Hospital. Maimonides provides state-of-the-art obstetrics and gynecology facilities including gynecology operating rooms and obstetrics delivery suites in one combined location. The program has one of the most advanced computerized systems in the country as well as advanced diagnostic and surgical facilities.

Obstetrics & Gynecology Primary Care Program

In line with the institutional commitment of the medical center, the Obstetrics & Gynecology Residency Program has restructured the program to include, in addition to a broad exposure to all subspecialty areas, an emphasis on primary care for women in a dedicated continuity care clinic. Our program in primary care provides training in longitudinal and comprehensive patient care and addresses the social and behavioral issues of the primary care office setting while providing residents the opportunity for subspecialty block rotations. Graduates are prepared to take comprehensive care of women’s obstetric, gynecologic and health maintenance needs, from adolescence through geriatrics, by being able to manage disorders beyond those of the reproductive system. Residents will spend a significant part of their training in continuity clinics where they will provide comprehensive health care to the same panel of patients for the duration of their residency training.

The Obstetrics & Gynecology primary care model encompasses high-quality, family-oriented primary care at an accessible facility and a graduate medical education program, which helps to guarantee both quality clinical service delivery and the training of physicians in both hospital and community-based settings. Also, the model encompasses a full range of complementary preventive, health education and health awareness programs. A broad array of specialists and subspecialists at Maimonides support the primary care program. To support this emphasis, a primary care lecture series incorporates education in preventive medicine, epidemiology, computer skills and bio-statistics, ethics, interviewing skills and cost-effective management. The program is designed to teach residents to work cooperatively with our nutrition, home care and social services departments to provide a comprehensive range of care and support to patients.

Finally, graduates of the Obstetrics & Gynecology primary care program will be competent and knowledgeable providers to women, qualified to perform the following procedures: vaginal deliveries, Cesarean deliveries, vaginal births after Cesarean delivery, vaginal breech deliveries, forceps and vacuum deliveries, abdominal and vaginal hysterectomies, surgery for urinary incontinence, adnexal surgery, minor gynecological procedures, diagnostic and operative laparoscopy, postpartum sterilizations, neonatal intubations, amniocentesis, and ultrasonography. Residents will also be able to manage uncomplicated pregnancies, medically complicated pregnancies, multi-fetal pregnancies, bleeding during pregnancy, high-risk pregnancies, gynecologic oncology vases, infertility, and reproductive endocrinology cases.

Obstetrics & Gynecology Subspecialty Education and Training Program

Well-developed specialty divisions in Obstetrics & Gynecology support this experience.

Obstetrics and Benign Gynecology

The Division of Obstetrics provides a broad obstetric experience with approximately 6,000 deliveries per year. The population is one-third service and two-thirds private patients. The program emphasizes the management of high-risk patients. Women with prior C-sections are encouraged to undergo a trial of labor. The use of forceps and vacuum extractions are also encouraged when appropriate, rather than immediately resorting to Cesarean deliveries. External cephalic versions of breech presentations are performed. The active management of labor results in a low Cesarean section rate, ranging between 15% and 18% over the last few years. Our population is ethnically and culturally diverse, providing for a varied exposure to people, their lifestyles, and their health problems.

The Division of Benign Gynecology performs approximately 2,000 major and minor surgical procedures annually. The medical center has two operating theaters specially equipped for gynecological procedures including vaginal/urologic surgery, abdominal pelvic surgery, operative endoscopy, laser surgery, microsurgery and minimally invasive surgery. These operating rooms are part of the obstetrical suites. Residents scrub with supervising faculty on all major and minor cases and are given surgical responsibilities commensurate with their level of expertise.

Coney Island Hospital (CIH) is part of the New York City Health and Hospitals Corporation, and the obstetrical and gynecological rotations of the residents through this hospital contribute greatly to their training. Annually about 1,000 deliveries are performed at CIH—a large proportion of them considered high risk. Residents with attending supervision perform approximately 2,000 major and minor gynecological procedures. Residents at CIH assume direct, hands-on responsibilities for an unusually broad range of clinical problems. As at Maimonides, the clinical work is continually supplemented with ongoing didactic lectures and conferences.

Division of Gynecologic Oncology

Board-certified teaching attending physicians supervise residents in the Division of Gynecologic Oncology. Each year more than 400 patients are admitted and treated for pelvic malignancies with radical pelvic surgery and/or radiation and chemotherapy. Outpatient visits to tumor clinics at both hospitals total about 750 visits per year. Selected cases are discussed weekly at multidisciplinary conferences and at the monthly Tumor Board at both hospitals.

The division also operates a large colposcopy service supervised by the two attending physicians. There are also two colposcopy clinic sessions at Coney Island Hospital. Laser surgery, LEEP procedures and hysteroscopy are performed on an outpatient basis. Radiotherapy is conducted at Maimonides by the Radiotherapy Department. The gynecologist and radiotherapist perform cesium insertions jointly.

Division of Reproductive Endocrinology and Infertility

The division is run by two obstetrician/gynecologists with subspecialty training in reproductive endocrinology and provides care to women who require treatment for an array of medical conditions:

• Infertility (difficulty in conceiving or maintaining a pregnancy, due to an ovulatory disorder, tubal blockage, uterine anomalies, low sperm counts, etc.)
• Endometriosis
• Fibroid tumors
• Ovarian tumors
• Menstrual abnormalities
• Premenstrual syndrome (PMS)
• Abnormal hair growth
• Hormonal abnormalities
• Menopausal and related disorders
• Disorders of puberty

The division offers a full complement of services for female reproductive disorders. Semen analysis for evaluation of male fertility is also available on the premises at the Maimonides Fertility Laboratory.

Residents are trained in fertility therapies including ovulation induction, intrauterine insemination, donor insemination, in vitro fertilization, and GIFT, ZIFT, and ICSI procedures. Additionally, they are trained in diagnostic and operative laparoscopy, hysteroscopy, laser surgery and microsurgery.

Division of Urogynecology and Pelvic Reconstructive Surgery

A faculty member who is a fellowship-trained urogynecologist and pelvic surgeon directs the Division of Urogynecology.

Residents receive hands-on clinical experience in the field, in both the hospital and private office setting, and are instructed in the evaluation, management and treatment of problems relating to the female urogenital tract, including urinary incontinence, urogenital prolapse and bladder pain syndromes.

Division of Maternal Fetal Medicine

The division of maternal fetal medicine has the latest diagnostic modalities available, some of which were developed at Maimonides, through which 10,000 diagnostic procedures are performed annually. The division also has a wide variety of research interests, several of which are federally funded. Maternal-fetal medicine specialists make teaching rounds with the residents on the obstetrics service twice each day.