Residency Program

Labor and Delivery

Residents in our program have exposure to L&D throughout their four years. At Los Angeles General Medical Center, residents are exposed to high-risk deliveries in the first, second and fourth years. External rotations at Kaiser Panorama City (R2 year) and Good Samaritan Hospital (R3 year) allow access to lower risk delivery experience and allow exposure to different care delivery models. Together at these three facilities, the residents are exposed to over 10,000 deliveries a year.

Most deliveries are performed by the junior resident under the supervision of the senior resident and faculty. The junior also is the primary surgeon for most of the cesarean sections. As Los Angeles General Medical Center is a major referral center for high-risk pregnancies, residents learn to manage patients with medical conditions ranging from diabetes to cardiac disease, as well as complications of pregnancy such as preterm labor and severe preeclampsia. The schedule is divided into day and night floats, with rare 24-hour weekend shifts. The schedule is designed to optimize continuity and be in compliance with Accreditation Council for Graduate Medical Education (ACGME) clinical hours requirements.

On Call Gynecology

The main exposure to gynecologic consultation and emergency surgeries is during the second and third years of residency. During the day, there is a 2-person team where residents respond to gyn consults from the ED and other services. There is also a separate night float rotation in the third year that allows for independence in consultation and direct training with the on-call faculty member.

Gyn Clinic/OR

Two rotations each year are focused on ambulatory and surgical gynecology at LALos Angeles General Medical CenterC+USC Medical Center and Keck Hospital. Residents are grouped into a four-person team, one resident for each year of residency. The daily schedule rotates with one team in the clinic at Los Angeles General Medical Center, while the other team is in the operating room at either Los Angeles General Medical Center or Keck. The teams are on 24-hour call every other Saturday, covering both Labor and Delivery and Emergency Gynecology. The residents on the team participate in activities that are most appropriate for their level of training. Starting in the first year, residents act as the primary surgeon for procedures of increasing complexity, from laparoscopic tubal fulgurations for the first years to vaginal hysterectomies and repair of pelvic organ prolapse for the third years. Residents also become proficient at vaginal ultrasonography, early in their training.

Each case that goes to the operating room at Los Angeles General Medical Center has been thoroughly prepared for surgery by the residents themselves, from the initial new patient visit through preoperative consultation. With assistance from faculty and the more senior trainees on the team, the residents learn how to perform a thorough preoperative evaluation, to counsel patients on treatment options, both medical and surgical, and to develop an operative plan that is most appropriate for each patient. The gynecology rotation also provides residents with valuable interaction with senior faculty members, in both the operating room and the clinic. After four years of training, graduating residents are competent to independently manage benign gynecologic conditions, both medically and surgically.

External Surgical

Third-year residents augment their operative experience with rotations at Kaiser Permanente Panorama City, and the fourth years at Huntington Memorial Hospital. Overall, more than 5,000 major and 3,000 minor gynecologic surgeries are available to residents each year. Their experiences at these locations are designed to increase their exposure to variations in care, supplement their surgical technical exposure and allow them to experience managed care and private practice models of practice. In addition, it allows exposure to the Kaiser system, which is a major employer in California.

The second- and fourth-year residents each spend one block managing high-risk antepartum patients. The team works in concert with the MFM fellow and attendings and manage both the inpatient service and the outpatient clinics. Complicated antepartum patients are managed by the MFM team, who also consult on the delivery management of complicated peripartum patients. In MFM Clinic, residents gain experience with routine and complicated prenatal care, and have specific clinics dedicated to pregnant women with diabetes, cardiovascular disease, thyroid disease, mental health issues and fetal anomalies. Direct teaching by the Maternal-Fetal Medicine faculty is abundant, both at morning pass-on rounds and during conferences several times a week.

In the first year, residents are exposed to routine prenatal care with our midwife team, and rotate in the MCA clinic, which is focused on the prenatal care of patients with HIV. The PGY1 on this rotation also works with the MFM team, learning how to provide prenatal care with the less complicated MFM patients in the outpatient setting.

Residents rotate on the REI service for one half block each during the first and second years. During the REI rotation, the residents see up to 5,700 patients in clinic annually, under the supervision of the REI fellows and faculty. Routine clinic procedures include intrauterine insemination, hydrosonography and diagnostic hysteroscopy. The clinic patient population ranges from common problems such as polycystic ovary syndrome to more rare conditions such as Müllerian agenesis. Residents also get exposure to andrology and male-factor infertility, during a monthly male clinic. REI has a dedicated operating room every week, where residents assist the fellow and are exposed to advanced laparoscopy, hysteroscopy, and tubal surgery. Finally, although in vitro fertilization (IVF) and other assisted reproductive techniques are not offered at Los Angeles General Medical Center, interested residents are encouraged to spend time at the USC IVF Center.

Residents spend one block each year on the Gynecologic Oncology service. Here residents gain experience in critical care and the management of complicated medical and surgical cases, under the supervision of the gynecologic oncology fellows and faculty. Residents on the rotation are also active participants in the operating room four days a week. In the oncology clinic, residents see a wide range of patients, with approximately 11,000 clinic visits a year. This is also where residents learn the most about the management of dysplasia and gain experience with colposcopy and LEEP. Throughout the rotation, residents interact with faculty on a daily basis, both in the operating room and in clinic, as well as on ward rounds. Residents also participate in multidisciplinary conferences weekly, which are attended by gynecologic oncology fellows and faculty, as well as outstanding faculty in gynecologic pathology and women’s radiology.

Residents spend one block on the Urogynecology service during their second year. Residents gain exposure to the subspecialty in the urogynecology clinic. Here they become proficient in performing multi-channel cystometrics and are exposed to cystourethroscopy, botox injections, posterior tibial nerve stimulation and bladder instillations. They also become proficient in the medical and surgical management of urinary incontinence and pelvic organ prolapse. As a referral center for complicated pelvic floor dysfunction, residents are exposed to a variety of complicated pelvic floor disorders, ranging from defecatory dysfunction to congenital pelvic floor anomalies. In the operating room, residents act as primary surgeons for appropriate aspects of incontinence and pelvic floor procedures, under the supervision of the Female Pelvic Medicine and Reconstructive Surgery fellows and faculty.

Residents rotate on the Complex Family Planning rotation during their first year. They work closely with the Family Planning fellows and faculty in the Reproductive Choice clinic to participate in and perform all of the procedures, to their comfort level. Family planning is a rotation where residents learn to provide trauma-informed care and learn to optimize their techniques for shared-decision making. We are a Ryan training program for residents and have a two-year fellowship in Family Planning.

In the third and fourth years, residents design their own clinical experience to meet their individualized learning needs for half a rotation in the third year and half a rotation in the fourth year. All rotations must be approved by the program directors and completed at a Los Angeles Department of Health Services facility. Examples have included rotations with a focus on: advanced ultrasound training, ICU care, advanced complex family planning, developing advocacy curricula, healthcare administration, and many others.

To accommodate residents taking time off for scholarly symposia, interviews, illness and other life events, we have a backup system where the backup person is assigned specifically to the backup (jeopardy) rotation. Residents on this rotation may expect to be called in most days to cross cover wherever they are needed. This allows for more focused experiences on all other rotations.

Uterine Cavity Clinic

Residents develop comfort with endometrial evaluations during the weekly Friday Uterine Cavity Clinic, which is designed to individualize evaluations with either sono-hysterography or office hysteroscopy. Residents are assigned to this clinic during various rotations throughout their four years and learn to manage abnormal uterine bleeding, with and without intracavitary lesions.

Colposcopy

Every other Friday afternoon, the gynecology clinic at Los Angeles General Medical Center hosts the Colposcopy clinic. Patients with abnormal cervical cytology are referred from across LA to have colposcopy with our team. Most low-risk colposcopy is performed by our Nurse Practitioners, while the high-risk colposcopies and occasional low risk cases are managed by the residents with direct faculty supervision.

Breast Medicine

Every other Friday afternoon, the gynecology clinic at Los Angeles General Medical Center hosts the Breast Diagnostic Center, which is staffed by faculty who are experienced in the diagnosis and management of breast disease. Residents are assigned to the clinic during various rotations throughout their four years and learn to manage patients with problems ranging from breast masses to mastalgia to granulomatous mastitis.

All residents are required to complete and present at least one research project in order to qualify for graduation. Projects are presented at an annual Departmental Research Day each spring, where USC residents at all levels are invited to present their research to their fellow residents, faculty and invited guests. Residents are also encouraged to present their research at regional and national meetings throughout the year.