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 24 residents, with six residents at each level and a teaching staff of 30 faculty physicians, including individuals certified in all subspecialties, 43 voluntary attending physicians, 13 certified midwives, and six full-time physician assistants. Coney Island Hospital has a dedicated group of faculty physicians who are involved with 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 includes, 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 spend a significant part of their training in continuity clinics where the goal is to 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 near to the hospital. This graduate medical education program 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. 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 in need of these services.
Finally, graduates of the Obstetrics & Gynecology program are competent and knowledgeable providers to women, qualified to perform the following procedures: vaginal deliveries, Cesarean deliveries, vaginal births after Cesarean delivery, vaginal breech deliveries, vacuum deliveries, abdominal and vaginal hysterectomies, surgery for urinary incontinence, adnexal surgery, minor gynecological procedures, minimally invasive surgeries, postpartum sterilizations, 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 cases, infertility, and reproductive endocrinology cases.
Obstetrics & Gynecology Subspecialty Education and Training Program
Well-developed specialty divisions in Obstetrics & Gynecology support this experience. These include:
Obstetrics and Benign Gynecology
The Division of Obstetrics provides a broad obstetric experience with approximately 8,000 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(TOLAC). The technique of vacuum extractions are also encouraged when appropriate, rather than immediately performing a Cesarean delivery. External cephalic versions for 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, and minimally invasive surgery. These operating rooms are part of the obstetrical suites. The minimally invasive program provides exposure to both robotic and laparoscopic surgery. 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 gynecologic rotations of the residents through this hospital focus on ambulatory care. Residents are exposed to family planning and are taught the principles of counseling patients with regard to choosing the best option for them. Ambulatory procedures, like colposcopy, endometrial biopsies, cryosurgery and LEEP are provided during this portion of their training. Residents with attending supervision perform approximately 2,000 major and minor gynecological procedures. Residents at CIH are able to 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 conference which is presented to physicians who are responsible for the direct care of the patients.
The division also operates a large colposcopy service supervised by the members of the oncology division. 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 a team of obstetrician/gynecologists who have subspecialized in reproductive endocrinology and infertility. The group 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.)
- Fibroid tumors
- Ovarian tumors
- Menstrual abnormalities
- Premenstrual syndrome (PMS)
- Abnormal hair growth
- Hormonal abnormalities
- Menopausal and related disorders
- Disorders of puberty
The division also offers a full complement of services for female reproductive disorders. 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.