Over the course of the programs, residents rotate among the following services:

Obstetrics
Gynecology
Gynecologic oncology
Reproductive endocrinology and infertility (REI)
Primary care
Urogynecology

Obstetrics
Since Baylor receives referrals from all over North Central and Northeast Texas, it has a large proportion of complicated and high-risk obstetrics. Last year, more than 4,000 babies were born at Baylor. In 2006 Baylor completed a renovation of the labor and delivery area. The postpartum unit is undergoing a multimillion dollar renovation which should be completed in 2008. Baylor University Medical Center is a Christian based hospital, as such, training in elective termination of pregnancy is a procedure not offered on the Baylor Health Care System campus, but we have arranged for those residents who wish training to have an elective in family planning at another institution.

On this service, the resident gains experience with vaginal deliveries, C-sections, operative vaginal deliveries (forceps, vacuum extraction, rotations, etc.), tubal ligations, and all related complications. Under the supervision of an attending physician, residents learn to manage normal labor, abnormal labor, pre-term labor, post-term labor, multi-fetal pregnancies, induction of labor, and inhibition of labor. They have hands-on experience with hypertension, infection, and hemorrhage. They learn how to manage co-morbid conditions that can complicate a pregnancy, including diabetes, cardiac disease, and connective tissue disorders.

Residents spend at least three months of each year on the obstetrics service; they spend four months on the service during their second year utilizing a night float system of call. Residents spend about two half-days per week in the outpatient (continuity of care) clinic.

The perinatologists on staff at Baylor are part of a high-risk referral/outreach program that regularly receives transfers from the outlying communities via ambulance or helicopter. Residents spend three months working with the perinatologist on the maternal-fetal medicine service. While on this service, residents gain experience in sonography, genetic counseling, prenatal testing, high-risk evaluation, and high-risk follow-up.

Gynecology
Ranked as one of the nation's best 50 Hospitals in U.S. News and World Report for twelve years, the gynecological service includes more than 30 private practice gynecologists on the medical staff at Baylor. Last year, surgeons performed more than 2000 major gynecologic procedures and more than 1200 minor gynecologic procedures at Baylor. Residents gain experience in such standard procedures as abdominal hysterectomies, vaginal hysterectomies, and tubal ligations, as well as more complex surgeries, including operative laparoscopy, operative hysteroscopy, endometrial ablation/resection, LAVH, LASH, urogynecologic procedures, and tubal microsurgery.

There are five residents on the gynecology team, including a chief and third-year resident who work together as a team for three months. The rest of the team is comprised of a rotating third-year resident, a second-year resident, and an intern. The gynecology team sees its ambulatory patients in the outpatient (continuity-of-care) clinic three half-days per week. A member of the attending/faculty team staffs this clinic. The attending staff on call supervises all clinic surgeries for any given day.

A team of attending faculty makes sure one of its members is in the clinic, is present for teaching rounds, and is available for consultations.

Gynecologic Oncology
Residents spend four months on the gynecologic oncology service, participating extensively in both inpatient and outpatient management of oncology patients. They gain experience in chemotherapy, work-ups of new patients, treatment planning, surgery, and follow-up. There are no oncology fellows; the resident typically acts as the primary surgeon under the supervision of one of four gynecologic oncologists. In more complex cases, such as pelvic exenterations, the resident may act as a second assistant. The Gyn-Oncologists also moderate a gynecology tumor conference weekly to assist the residents in understanding staging procedures and grading.

The surgical skills learned on this rotation are invaluable even in general practice. Last year, the service performed more than 200 major surgical procedures for invasive disease. Because there are no fellows on this service, the residents are very actively involved in surgery and care.

The gynecologic oncologists on the medical staff at Baylor belong to a large statewide oncology group with offices in many cities in Texas. Thus, the resident physician will encounter a wide spectrum of oncology patients.

Reproductive Endocrinology and Infertility (REI)
Over the course of the program, Baylor residents spend three months on the endocrine service: one month as a second-year resident, one month as a third year resident and one month as a fourth-year resident. Under the supervision of the reproductive endocrinologists on our medical staff, residents participate in all phases of evaluation and treatment of infertility and related reproductive endocrine disorders. The resident on service also learns how to perform vaginal ultrasound for monitoring of ovulation, semen analysis, post-coital tests and semen preparation for intrauterine insemination. Assisted reproductive techniques performed at Baylor include in-vitro fertilization, embryo transfer, intracytoplasmic sperm injection, ZIFT, and GIFT. The surgical experience focuses on basic and advanced operative laparoscopy, in addition to microsurgical procedures and operative hysteroscopy.

Primary Care
The residents have a month rotation in one of the OB/GYN generalists office within the Baylor Health Care System. The residents are instructed and graded on the “20 Elements of Primary Care” as required by the ACGME in the private offices and in the continuity of care clinics. The residents also rotate for one month on the Internal Medicine Service and one month in the Emergency Department. To familiarize the residents with the many facets of primary care medicine, we invite family practice and internal medicine faculty to participate in the core lecture series utilizing the CREOG Educational Objectives for Primary and Preventive Ambulatory Care.

Urogynecology
The 2nd, 3rd and 4th year residents spend one month on the urogynecology service for a total of three months of urogynecology experience during the four years of their residency. The residents will be in the urogynecology office where they will learn urodynamic evaluation and cystoscopy. They will also learn basic urogynecologic procedures as well as pre and postoperative management of these patients.