Rotation Schedule Overview

PGY-1

BLOCK 1 BLOCK 2 BLOCK 3 BLOCK 4 BLOCK 5 BLOCK 6 BLOCK 7 BLOCK 8 BLOCK 9
OB/GYN OB/GYN OB/GYN OB/GYN OB/GYN-Night Float MFM OB^ GYN ONC RESEARCH/VACATION

^OB rotation at California Hospital Medical Center

PGY-2

BLOCK 1 BLOCK 2 BLOCK 3 BLOCK 4 BLOCK 5 BLOCK 6 BLOCK 7 BLOCK 8 BLOCK 9
OB/GYN OB/GYN OB/GYN OB/GYN OB* GYN^^ GYN ONC REI RESEARCH/VACATION

*OB rotation at Good Samaritan Hospital
^^Gyn rotation at Keck Hospital of USC

PGY-3

BLOCK 1 BLOCK 2 BLOCK 3 BLOCK 4 BLOCK 5 BLOCK 6 BLOCK 7 BLOCK 8 BLOCK 9
OB/GYN OB/GYN OB/GYN OB/GYN OB* GYN+ GYN** GYN ONC RESEARCH/VACATION

*OB rotation at Good Samaritan Hospital
+Gyn rotation at Huntington Memorial Hospital
**Gyn rotation at Kaiser Permanente Panorama City

PGY-4

BLOCK 1 BLOCK 2 BLOCK 3 BLOCK 4 BLOCK 5 BLOCK 6 BLOCK 7 BLOCK 8 BLOCK 9
OB/GYN OB/GYN OB/GYN OB/GYN MFM GYN ONC REI ELEC RESEARCH/VACATION

Gynecology

Each resident spends four blocks–approximately six months–each year on the obstetric/gynecology service, making up a total of four teams, with a member from each class on all four teams. The daily schedule is based on a “q4” call rotation. Each weekday, one team is in the clinic, one is in the operating room, one is on-call, and one is post-call. In lieu of 24 hour call, the first year class has a night float rotation that allows all rotations to be in compliance with ACGME duty hours requirements. During each day of the obstetric/gynecology rotation, 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. Third year residents augment their operative experience with rotations at Kaiser Permanente Panorama City, Huntington Memorial Hospital, and Keck Hospital of USC.

Overall, over 5,000 major and 3,000 minor gynecologic surgeries are available to residents each year. Furthermore, each case that goes to the operating room at LAC+USC 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.

Obstetrics

The obstetric experience at USC is divided between LAC+USC Medical Center, California Hospital Medical Center, and Good Samaritan Hospital, all overseen by the USC Perinatologists. Together, these facilities account for 17,000 deliveries attended by the residents each year. Residents spend the most time on the obstetrics service at LAC+USC Medical Center. Each resident spends four blocks–approximately six months–each year on the obstetric/gynecology service, making up a total of four teams, with a member from each class on all four teams. The daily schedule is based on a “q4” call rotation. Each weekday, one team is in the clinic, one is in the operating room, one is on-call, and one is post-call. During each day of the rotation, the residents on the team participate in activities that are most appropriate for their level of training. Most deliveries are performed by the junior resident under the supervision of the senior. The junior also is the primary surgeon for most of the cesarean sections. As LAC+USC 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 fourth and first year residents will spend one block managing high-risk antepartum patients.

At California Hospital Medical Center and Good Samaritan Hospital, residents perform a high volume of deliveries under the supervision of both USC full-time faculty and volunteer “private” attending physicians. At both private hospitals, the attendings encourage residents to participate actively in the deliveries, and the resident on-call is the primary surgeon for most cesarean sections on the attendings’ private patients. First year residents will spend one block at California Hospital Medical Center and second and third year residents will each spend one block at Good Samaritan Hospital. On all obstetrics rotations, teaching by the Maternal-Fetal Medicine faculty is abundant, both at morning pass-on rounds and during conferences several times a week. Furthermore, there is extensive training in ultrasound at all three facilities, both in clinic and on L&D.

Reproductive Endocrinology and Infertility

Residents rotate on the REI service for one block each during the 2nd and 4th 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 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 and other assisted reproductive techniques are not offered at LAC+USC Medical Center, interested residents are encouraged to spend time at the USC IVF Center, located at Good Samaritan Hospital.

Gynecologic Oncology

Residents spend one block each year on the gynecology 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.

FPMRS/Urogynecology

While there is no formal urogynecology rotation, residents gain exposure to the subspecialty each year during the ob/gyn rotation. Furthermore, second year and senior residents each spend one day per week in the urogynecology clinic during their gynecology rotations. Here they become proficient in performing multi-channel cystometrics, and are exposed to cystourethroscopy, botox injections and bladder instillations. They 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 on the gynecology service also act as primary surgeons for most incontinence and pelvic floor procedures, under the supervision of the Female Pelvic Medicine and Reconstructive Surgery fellows and faculty.

Breast Medicine

Every Friday afternoon, the gynecology clinic at LAC+USC 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 see patients with problems ranging from breast masses to mastalgia. Residents gain experience with fine needle aspiration and breast ultrasound and learn the appropriate management of masses and mammographic lesions.

Family Planning

USC residents have the opportunity to participate in the Reproductive Choice clinic and participate in all the procedures performed by the fellows and faculty. There is a Ryan training program for residents in addition to the two-year fellowship in Family Planning supported by a foundation grant.

Research

All residents are required to complete and present one research project in order to qualify for graduation. Projects are presented at an annual Residents’ 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 meetings throughout the year.