Residency Program Overview
Facilities
The Wake Forest University School of Medicine residency program in Obstetrics and Gynecology is located in Winston-Salem, North Carolina, a city of about 200,000 people, in Forsyth County. The principal affiliated hospitals, North Carolina Baptist Hospital (NCBH) and Forsyth Medical Center (FMC), are located in Winston-Salem with an additional Area Health Education Center (AHEC) hospital, Catawba Memorial Hospital (CMH) located in Hickory, North Carolina (about 70 miles west of Winston-Salem on Interstate 40).. The principal referral area includes Northwest North Carolina, Southwest Virginia, Southeast West Virginia and Eastern Tennessee, an area of greater than three million people with approximately 30,000 deliveries per year. Additional referrals come from proximate communities to the east and south of Winston-Salem.
The Wake Forest University School of Medicine (WFUSM) and NCBH are co-located in the Ardmore section of Winston-Salem. The tertiary care hospital has 821 beds and serves as the primary site for gynecologic oncology, reproductive endocrinology, and complicated general gynecologic care. Residency programs in almost all specialty and subspecialty areas of medicine are available with a total house staff complement of over 500 physicians.
The Forsyth Medical Center (FMC), a facility of 805 beds, houses our unique consolidated perinatal service in a well equipped Women's Center (The Sara Lee Center for Women’s Health) which was opened in March 1992. The Sara Lee Center for Women’s Health is one of the largest birthing centers in the region, and the second largest in North Carolina with more than 6,600 births per year. The Center offers the only obstetrical service for a four county area (Forsyth, Davie, Stokes, Yadkin) with about 422,000 inhabitants. This is of particular importance in the present rapidly changing medical climate where frequently large segments of patient populations have been shifted away from teaching institutions. With a single obstetrical service this cannot happen for our residency program. There has been a continuing increase in the number of deliveries requiring expansion of the current facility at FMC. A 30 million dollar addition to the Sara Lee Center is currently in the final stages of completion.
Under the aegis of North Carolina's Area Health Educational Program, Catawba Memorial Hospital (CMH) in Hickory has been developed as a level II care institution. Each third year resident rotates for 10 weeks on the gynecology service attending gynecology, colposcopy and cervical treatment clinics at the county health facility and private physicians offices. This rotation is highly valued by our residents for the extensive gynecological surgical experience. This rotation also affords our residents an opportunity to experience the practice of our specialty in a non-ivory tower environment.
Ambulatory patient care is delivered at several locations:
· Downtown Health Plaza The Downtown Health Plaza (DHP), a NCBH Outpatient Department, is located in east Winston-Salem and delivers ambulatory care in medicine, pediatrics, and obstetrics and gynecology to indigent and semi-indigent patients. In September 1993, a continuity clinic system was implemented allowing residents to follow their own patients during the four years of their residency under direct faculty guidance. This arrangement provides our residents with important educational experiences in primary care.
· Shepherd Street In December 2005, the Department opened our new OBGYN clinic at 500 Shepherd Street (about 5 miles from the Medical Center campus. Residents staff a weekly LEEP, laser, cryotherapy clinic at this location.
· Comprehensive Fetal Care Center Connected to our Shepherd Street Clinic is the Comprehensive Fetal Care Center (CFCC). The CFCC houses six ultrasound suites with 4D ultrasound technology. Here, our residents work with our Maternal Fetal Medicine specialist, six certified sonographers, genetic counselors and cadre of other fetal care specialists.
· Comprehensive Cancer Center The residents staff a colposcopy clinic with our GYN Oncology section once a week in the Comprehensive Cancer Center.
· WFU Center for Reproductive Medicine In 2003, the Department completed construction of the WFU Center for Reproductive Medicine (WFUCRM), home to our reproductive endocrinology and infertility clinic. The center features a state of the art on-site IVF lab with an adjoining procedure suite.
Faculty
The Department of Obstetrics and Gynecology has a full-time faculty of 18 faculty members including three Maternal-Fetal Medicine Fellows who have faculty appointments at the instructor level. In addition, residents at the HO II and above levels also have faculty appointments as Assistants in Obstetrics and Gynecology. The department is chaired by Dr. David C. Merrill. Dr. Robert C. Henderson is the Residency Program Director and Head of the Section o Gynecology. Dr. David Merrill also heads the Maternal-Fetal Medicine Section while Dr. Brigitte Miller is head of the Section on Gynecologic Oncology. All faculty members actively participate in patient care, undergraduate and graduate medical education, and in clinical and/or basic research. The department has a long tradition of basic research and many of its members have been recognized nationally and internationally for their achievements.
Clinical Education
The residency training program in Obstetrics and Gynecology was reviewed and approved in 2001 until the year 2005 for 20 residents, five at each level, for four years with progressive increases in delegated responsibility at each level. Less than 10% of residency programs reviewed in 2001 received an approval of more than three years. The program differs from many in that the first year is spent entirely on obstetric and gynecologic services. Since progression through the residency is contingent upon satisfactory performance, we feel it necessary to personally evaluate our residents during the first and what is most often described as the most difficult postgraduate year after medical school. Secondly, the basis of excellent complicated obstetrical and surgical care depends upon a solid foundation in normal obstetrics and on comprehensive pre- and postoperative evaluation and management. These skills are best learned from normal obstetrical patients on the one hand and in the care of seriously ill patients who require extensive surgical procedures on the other. During the second year our residents receive education in primary health care of women during rotations through the Departments of Family Medicine and Emergency Medicine for a period of 10 weeks. Emphasis is on ambulatory primary care during this time period. The remainder of the primary care experience is obtained by rotating through both the Oncology private offices and the continuity clinics at the Downtown Health Plaza. During the second year a 10 week rotation in the Prenatal Assessment Center (PAC) and Comprehensive Fetal Care Center (CFCC) provides extensive ultrasound, amniocentesis, and fetal heart rate monitoring experience. This rotation follows participation in an Ob/Gyn ultrasound course at the Wake Forest Center for Medical Ultrasound during the first year. During the 10 week PAC/CFCC rotation, the resident has time allotted to design and begin his/her resident research project. Residents rotate at CMH in Hickory for 10 weeks during their third year of residency for additional gynecologic experience. An additional 10 week rotation with Dr. Ed Levine in the Department of General Surgery gives the third year resident experience in outpatient breast surgery and inpatient abdominal surgery and one half day a week during this rotation allows the resident to learn urogynecology skills. Residents also rotate through the private offices in the Sections on Reproductive Endocrinology, Oncology, and Gynecology.
The numbers of outpatient visits, normal and high risk deliveries, and major and minor surgical procedures available for resident education, are most adequate to assure exposure to all routine problems of our specialty and many of the unusual problems as well. The inpatient case load for the academic year 2001-2002 is shown on the Website under "Surgical Case Load". In the three hospitals, 4,962 major gynecologic operations and 3,194 minor gynecologic operations were performed. The number of outpatient visits for the academic year 2001-2002 was 46,506. The distribution of these visits in the various general and specialty clinics is shown on the Website.
The delivery and operative experience records of five recent graduates of our program illustrate the volume of cases that a resident can expect to have performed during his/her four year experience (see "Average Case Experience" on the Website). The program provides exceptional training in gynecological surgery and operative obstetrics while limiting the routine service load (vaginal deliveries). The progression of responsibility from second to first assistant to principal surgeon on private cases to principal surgeon with attending assistance on service cases, enables faculty to assure that a resident is gaining proper judgmental and operative skills.
Didactic Education
Grand Rounds are held each Wednesday at 7:30 a.m. at FMC. High risk obstetrical conferences and rounds are held daily. There is a reproductive endocrinology conference every Tuesday at 12:00 p.m. A teaching conference is held each Monday at 4:00 p.m. for our residents and house officers rotating from other services. During this time, topics of fundamental importance are reviewed. The content of these conferences is designed to cover the educational objectives of the Council on Resident Education in Obstetrics and Gynecology. This 4:00 p.m. conference is followed by a bimonthly morbidity and mortality conference during which management of cases from the previous month is discussed. On alternate weeks, electronic fetal monitor strips or case presentations are discussed. A weekly pathology/oncology conference as well as a gynecologic oncology conference are presented by residents on the Oncology Service. Teaching rounds are held on all services. A conference of the Fetal Diagnosis and Treatment Center takes place twice monthly on Tuesday. Evening Journal Clubs are held 10 times a year on the second Monday of every month.
Since the large majority of residents completing any training program enter the private practice of general obstetrics and gynecology, it is the fundamental purpose of our program to train our residents appropriately for excellence in this area. Historically they have been very competitive for the best fellowship training programs and about 10% of senior residents have pursued subspecialty training. You will recall that house officers above the first year level have a faculty appointment in the medical school. We expect that our residents will actively participate in medical student education, both by formal teaching and during daily work rounds and patient management. All residents are required to do a research project under the guidance of a faculty member. The projects will be presented at an annual Resident Research Day. These research projects are expected to be of a quality that is acceptable for presentation at national meetings and publication in one of our specialty journals. An award is given for the best research paper funded by the Lock Society which is the organization of former residents in our department.
The performance of our residents in the in-training examinations as well as the written and oral specialty board examinations has been far above the national average.
In addition to the stipend and fringe benefits provided by the hospitals, the Department of Obstetrics and Gynecology makes available to each resident educational grants intended to offset the expenses of attending a scientific meeting or to pay for medical books. Any travel to a scientific meeting for presentation of a paper prepared by a resident is paid by the department. Residents are expected to attend the scientific and social programs of our annual Frank R. Lock Symposium as well as the annual meeting of the North Carolina Ob/Gyn Society. The Frank R. Lock Symposium, recognizing the department's first chairman, is held in the fall of the year and is a time when many of our former residents return for an educational and reunion experience. Every year at a social gathering the current resident selected by the third year medical students as the outstanding teacher in the program is presented a plaque recognizing this achievement. This emphasizes the importance of student teaching by residents. Each year the graduating medical school class selects one of the 512 residents at the Medical Center as the best student teacher. We are proud that during the eleven year period from 1991-2001 a resident from our program won this award eight of the eleven years.
Local Culture
Finally, some comments are in order about rest and recreation, areas which we believe are essential for a busy physician in his/her overall personal and family development. Winston-Salem is an educational center with Wake Forest University, Salem College, Winston-Salem State University, and the North Carolina School of the Arts. Old Salem heads the list of historical and cultural attractions which also include Reynolda House Museum and Gardens, the Southeastern Center for Contemporary Arts, the Museum of Southern Decorative Arts, musical and dramatic performances both at Wake Forest University, the Little Theater and by the Winston-Salem Symphony. The Stevens Center for the Performing Arts is a focal point of artistic activity. The North Carolina School of the Arts has sponsored a very successful Broadway preview series. The 1991 Tony Award winning play "Lost in Yonkers" had its world premiere in Winston-Salem. The Music at Sunset Concerts held outdoors at Tanglewood Park highlight the summer season. Winston-Salem had the first Arts Council in the nation and among cities of its size Winston-Salem is hard to match in terms of cultural offerings and has traditionally been at the very top in terms of per capita donations for the arts. For the sportsminded, a new modern YMCA and city park with running track and 12 clay tennis courts are only a few blocks from the medical school and there are exercise facilities available in the Medical School Student Center. Tickets for Wake Forest University varsity sports including ACC football and basketball are available at reduced rates for residents. Athletic facilities at Wake Forest University are open to residents as well. In addition, Winston-Salem is ideally located within one to two hours of numerous fishing and boating lakes and the Blue Ridge Mountains with the highest mountains in the eastern United States, which provide hiking and skiing facilities. The Atlantic Ocean with numerous beaches is about four hours away. In the Eastern United States the State of North Carolina offers the greatest geographic variety.