Queens Hospital Center: Obstetrics and Gynecology

Teaching and training residents; that is what we are about. Our Department's mission has always revolved around our residents. Although the affiliation with The Mount Sinai Health System is new, established in 1993, we have been a major teaching affiliate, training residents in Obstetrics & Gynecology for over 30 years. Our aim is to prepare our graduates to be well-trained generalists in Obstetrics & Gynecology and to provide care effectively in all aspects of Obstetrics & Gynecology from primary care to the most up-to-date and sophisticated procedures. Our graduates acquire the skills to serve the female patient as a primary contact for health care and to provide effective health maintenance by direct medical or surgical intervention or by way of counseling or referral as required by the patient's situation. Our graduates have gone onto fellowship training, academic medicine, and private practice, and in each case, our program has provided a strong background for continued growth. That is our measure of success.

Throughout their training, residents rotate through three hospitals.

Queens Hospital Center is a 300-bed acute care municipal hospital located in Jamaica, New York, which serves a culturally and economically diverse population with a large spectrum of medical problems. The hospital averages 2,000 deliveries and close to 50,000 OB/GYN visits per year. Queens Hospital Center has taken the lead in developing a full spectrum of primary care and specialty services. At Queens Hospital Center, approximately half of the ward experience is spent on the Obstetrics Service and half on the Gynecology Service. Residents also have a weekly continuity clinic. Resident specialty rotations in Colposcopy, Endocrinology, Ultrasound, and Breast Disease are also done at Queens Hospital Center.

Each year, PGY-III residents rotate to Parkway Hospital to expand their surgical experience in Gynecology. This hospital has a large number of gynecologic surgical cases, allowing residents to maximize their surgical experience.

Residents spend one month each during their PGY-II and PGY-III years at The Mount Sinai Health System getting a very intense education as part of their Gynecology Oncology team. They also spend an additional month during their PGY-III year expanding their experience in Endocrinology and surgical management of infertility.

The resident experience is also specifically geared towards preparing its graduates to be primary care providers in the new health care environment. Residents spend four months at the PGY-I level as primary care providers in the Medicine Outpatient Department at Queens Hospital Center. At the PGY-II level, they gain experience one month each in the Emergency Department and in Geriatric Medicine. The residents also gain knowledge by experience and instruction in nutritional planning, instruction, and monitoring, human sexuality, prevention and treatment of sexually transmitted diseases, psychosomatic obstetrics & gynecology, social medicine, legal medicine, and health care delivery. These experiences give our graduates the breadth of experience they need to succeed in their future practices.

Obstetrics

At Queens Hospital Center, all the patients are service patients. During the day, first- and second-year residents, under the direct supervision of the chief resident, are responsible for management of the Labor & Delivery floor. At night a third- or fourth- year resident manages the Labor & Delivery floor with the assistance of junior residents. There is always an attending in-house 24 hours a day to teach and act as a consultant to the residents. The postpartum floors are managed by the entire team. Daily attending rounds are conducted.

The Prenatal Clinic is staffed by physician assistants, nurse practitioners, and attendings. Each resident has a continuity clinic day during which he or she follows prenatal patients through his or her four years of residency. However, since most of the patients in the clinic are seen by others, the pressure to see a large volume of patients is removed in favor of an emphasis on learning.

High Risk Obstetrics

 

Patients on the High Risk Obstetrical Service have pregnancies with increased risks of adverse outcomes. Each third-year resident spends four months on this service. While on this rotation, the resident is responsible for all aspects of the care of these high-risk patients. Two high-risk clinics and a diabetic clinic are staffed by the resident under the direction of the Maternal-Fetal Medicine faculty. This resident also rotates through the Antepartum Testing Unit, being trained in level II ultrasound examinations and amniocentesis. Depending upon the nature of the procedure, the resident performs, observes, and/or assists in these activities. Postpartum high-risk patients are followed in a special clinic further to ensure continuity of care and follow-up for those requiring ongoing medical services. The Antepartum Testing Unit is outfitted with the most modem ultrasound equipment. Residents learn ultrasound by scanning their patients under the direct supervision of an attending.

The resident makes daily morning rounds with an attending to discuss all patients on the service and pertinent problems involving outpatients. The resident has ample opportunity to discuss cases in-depth directly with the Maternal-Fetal Medicine faculty member.

Biweekly perinatal teaching conferences are held throughout the month on the High Risk Obstetrical Service to enhance resident education, as well as monthly Maternal-Fetal Medicine/Pediatric Pathology conferences.

Benign Gynecology

On the Surgical Gynecology Service at Queens Hospital Center, a full range of surgical procedures are performed including major abdominal, vaginal, and laparoscopic surgeries. More than one-third of our hysterectomies are vaginal hysterectomies or laparoscopically assisted vaginal hysterectomies, indicating that Queens Hospital Center is keeping pace with the rapidly changing world of gynecologic surgery. Residents also train with faculty in urogynecology, colposcopy, breast disease, infertility, and hormone replacement therapy.

The Department has four full-day operating rooms each week. Ambulatory surgery cases, such as diagnostic laparoscopies, D&Cs, and first-trimester pregnancy terminations, are performed by junior residents under the supervision of attendings. Residents are given the opportunity to perform first-trimester pregnancy terminations, but are not required to participate if they have moral or religious objections.

The Department has designated specialty clinics for Urogynecology and Geriatric Gynecology. Second-year residents during their GYN rotation, and PGY-III and PGY-IV residents during their electives, rotate through the Breast Clinic, which is run by the Department of Surgery. This rotation affords residents the opportunity to diagnose and treat breast lesions. The Division of Benign Gynecology also supports the emergency room staff, where many patients with gynecologic problems are seen each year.

The inpatient service is supervised by the Physician-in-Charge of Gynecology who makes daily rounds with the residents. Inpatient benign gynecologic surgery and patient care management are performed by residents under the supervision of attendings. PGY-III residents rotate for four months at Parkway Hospital. There the main focus of the rotation is on operative gynecology. All patients there are evaluated by and surgeries performed by the GYN residents with attending supervision. There is a large ancillary staff to help with routine responsibilities. This frees the residents to concentrate on their surgical experience and the postoperative care of the patients.

Breast Education

During their GYN rotations, residents in the PGY-II year rotate to the Breast Clinic. This rotation is repeated during their PGY-III endocrine elective and PGY-IV senior elective.

Gynecologic Oncology

 

Residents gain experience in Gynecologic Oncology by rotating through this service at The Mount Sinai Health System during one-month blocks in their second and third years. During this time, the resident admits patients with gynecologic cancers, is instructed by a second-year fellow on the findings of all new admissions, attends a Colposcopy Clinic for dysplasia diagnosis, attends the Chemotherapy Clinic for gynecologic oncology patients, and attends the intake and follow-up clinics. In addition, the residents operate with the fellow and an attending on all patients with gynecologic cancers (average inpatient census: approximately 20-23 per day). A two- to three-hour weekly conference in gynecologic oncology also takes place in which all patients currently under treatment are reviewed with radiation therapists, chemotherapists, social workers, and other specialists.

Because there are no fellowship programs at Queens Hospital Center and Parkway Hospital, the chief resident on the Gynecology Service (or senior resident at Parkway Hospital) acts in the same role as a fellow and manages the patients directly with the attendings. During their dysplasia rotation (PGY-II and -IV years), residents attend the weekly tumor clinic where they initiate workups for patients with GYN cancer and attend to their long-term follow-up.

Queens Hospital Center is a center of excellence for the evaluation of patients with abnormal Pap smears. Residents rotate for two months each in the PGY-II and PGY-IV years on the Dysplasia Service at QHC. There they perform a large number of colposcopies and attend a weekly Dysplasia Review Conference where they correlate the histologic findings with the colposcopic appearance.

Infertility and Reproductive Endocrinology

All OB/GYN residents, throughout the four-year residency, attend an interactive didactic seminar every other week on the Endocrine-Infertility subjects listed in the CREOG Educational Objectives.

For two months in the PGY-II year and one month in the PGY-III and PGY-IV years, residents have a concentrated rotation in Gynecologic Endocrinology and Infertility at Queens Hospital Center. During these rotations, the resident attends each of the four weekly Endocrine-Infertility Clinics. At each clinic, large numbers of patients with gynecologic endocrinology and infertility problems are routinely seen, with the resident receiving instruction from the endocrinology attending on a one-on-one basis. The residents are taught endocrine-infertility history taking, physical examination, workups, differential diagnosis, and management, as well as the interpretation of laboratory tests. At these clinics, the resident also gains experience as required in endocrinology and infertility procedures. Prior to each clinic session, the attending and resident carry out a chart review and discussion of each patient scheduled for that clinic session. At Queens Hospital Center, all residents, PGY-I through -IV, under the supervision of the attendings, participate in infertility surgery, including diagnostic and operative hysteroscopy, diagnostic and operative laparoscopy including surgical management of endometriosis, and tuboplasty with microsurgical technique.

In addition, PGY-III residents have one one-month rotation at Mount Sinai where they have a further opportunity to gain surgical endocrine experience. They also spend time with the gynecologic endocrinologists learning about ovulation induction, IVF, and other advanced assisted reproductive technology.

Research and Senior Elective

All residents are required to do a research project and submit a paper on their work prior to completing the program. The philosophy of the Department encourages these academic pursuits. Residents are encouraged to choose their topics based on their areas of interest, but are actively assisted in structuring, completing, and reporting on their research. A majority of the research papers are ultimately published in peer-reviewed journals. During their PGY-Ill year, half of a month-long elective is devoted exclusively to research.

During the PGY-IV year, there is a two-month elective devoted to expanding the resident experience in ultrasound, urology, and breast disease. The ultrasound experience allows the resident to polish his or her skills in level II ultrasound and perinatal diagnosis. The urology experience allows the resident to enhance his or her skills in urodynamics and the management of urogynecologic disorders. The Breast Clinic experience builds on the skills that the resident developed in the same clinic during the first three years.

Obstetrics& Gynecology Residency Schedule

PGY-I

4 months Obstetrics, QHC
4 months Gynecology, QHC
4 months outpatient primary care, Medicine, QHC
4 weeks vacation

PGY-II

4 months Obstetrics, QHC
3 months Gynecology, QHC
2 months elective (Colposcopy, Endocrinology) QHC
1 month GYN Oncology, MSMC
1 month Geriatric Medicine, QHC
1 month Emergency Department, QHC
4 weeks vacation

PGY-III

4 months High Risk Obstetrics, QHC
2 months Gynecology, QHC
4 months Gynecology, Parkway Hospital
1 month elective MSMC (Endocrine, Breast disease, Research)
1 month elective (Colposcopy, Endocrinology) QHC
4 weeks vacation

PGY-IV

4 months Obstetrics Chief; QHC
4 months Gynecology Chief; QHC
2 months elective (Colposcopy, Endocrinology) QHC
2 months elective (Ultrasound; Urogynecology, Breast Disease) QHC
4 weeks vacation

Every resident has a continuity clinic every week in which he or she sees patients for whom he or she provides ongoing care during all four years of residency. Residents return from outside rotations to their continuity clinics.

Salaries and benefits are competitive.

For information and application, contact:
Keith B. Lescale, M.D., Director
Obstetrics & Gynecology
Queens Hospital Center
82-68 164th Street
Jamaica, NY 11432
Telephone: (718) 883-4035
Fax: (718) 883-6129