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.