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RESIDENCY REVIEW COMMITTEE FOR OBSTETRICS GYNECOLOGY

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      RESIDENCY REVIEW COMMITTEE FOR OBSTETRICS-GYNECOLOGY
              515 N State St., Ste 2000, Chicago, IL 60610 • (312) 755-5039 • www.acgme.org

                                  PROGRAM INFORMATION FORM
                                        TABLE OF CONTENTS
When you have the completed forms, number each page sequentially in the upper right hand corner.
Start on Part 1, Section 1 of the PIF. Report this pagination in the Table of Contents and submit this cover
page with the completed PIF.

Part 1                                                                                   Section Page(s)
General Program Information                                                              1         1
      Accreditation Information                                                          1.A       1
      Program Director Information                                                       1.B       1
Participating Institutions                                                               2         2-4
Resident Complement                                                                      3         5
      Number of Positions                                                                3.A       5
      Actively Enrolled Residents                                                        3.B       5-7
      Aggregate Data on Residents Completing or Leaving the Program for the Last
                                                                                         3.C       8
      Three (3) Years
      Residents Who Completed the Program                                                3.D       9-10
      Withdrawn / Dismissed Residents                                                    3.E       11
      Scholarly Activity                                                                 3.F       11
      Duty Hours                                                                         3.G       12-13


Part 2                                                                                   Section Page(s)
Narrative Description Of Program                                                         A         17 - 64
A1                                                                                                 17 – 18
A2                                                                                                 18
A3                                                                                                 18 – 19
A4                                                                                                 19 – 22
A5                                                                                                 23
A6                                                                                                 23 - 24
A7                                                                                                 24 – 46
A8                                                                                                 46 - 48
A9                                                                                                 48 – 52
A10                                                                                                52 – 53
A11                                                                                                53 - 54
A12                                                                                                54 – 57
A13                                                                                                57 – 61
A14                                                                                                61
A15                                                                                                61 – 62
                                                                                        16
A16                                                                           62 - 64
Program Director                                                        B     65 – 67
Program Director CV                                                           68
Faculty                                                                 C     69 – 71
Additional Trainees: Fellows In Training                                D     72
Additional Trainees: Ob-Gyn Residents from Other Institutions           E     73 – 74
Additional Trainees: Other Trainees Per Year Assigned To This Program   F     75
Organized Teaching Activities                                           G     76
Research And Publications                                               H     77 – 78
Medical Library Facilities                                              I     79
Residency Outline                                                       J     79 - 80
Institutional Data                                                      K     81 - 83
      Obstetrics - Profile of Program                                   K.1   81
      Gynecology - Profile of Program                                   K.2   82
      Primary and Pre Schedule                                          K.3   82
      Primary and Preventive Medical Services                           K.4   83
Content of The Curriculum                                               L     84 – 87
Status of Graduate Training Programs                                    M     88 – 96
Resident Case Logs                                                      N     97 – 99
      Resident Experience In Obstetrics                                 N.1   97
      Resident Experience In Gynecology                                 N.2   98
      Resident Experience in Primary and Preventive Medicine            N.3   99
      Attachment                                                              100 - 112

(FOR OFFICE USE ONLY)
10 Digit ACGME Program I.D. #:
Program Name:
                                                                                                 17

   RESIDENCY REVIEW COMMITTEE FOR OBSTETRICS-GYNECOLOGY
           515 N State St., Ste 2000, Chicago, IL 60610 • (312) 755-5039 • www.acgme.org

                      PROGRAM INFORMATION FORM (Part 2)

                          CONTINUED         ACCREDITATION           PIF


SECTION A. NARRATIVE DESCRIPTION OF PROGRAM
CONCISE ANSWERS ARE PREFERRED. (Limit one page maximum per numbered answer, except #7. Use
#12 font or greater for all responses.)

   1.   List the overall educational objectives of the program. Have specific objectives by year and
        by rotation available for the site visitor (do not attach).


        The vision of the Wayne State University/Detroit Medical Center
        Obstetrics and Gynecology Department is to be a leader in education and
        research as an academic department and to excel in the provision of
        women’s health care. The Department values quality, ethical integrity,
        innovation, and family, its role as an integral part of the community,
        entrepreneurial spirit, and fiscal integrity. The mission of the residency
        program is to graduate well-trained residents in clinical and didactic
        obstetrics and gynecology who meet the objectives outlined by the
        Association of Professors of Gynecology and Obstetrics (APGO), the
        American College of Obstetricians and Gynecologists (ACOG), the
        Council on Resident Education in Obstetrics and Gynecology (CREOG),
        the Accreditation Council for Graduate Medical Education (ACGME) and
        the American Board of Obstetrics and Gynecology (ABOG). Upon
        graduation, a resident should be able to


                        Satisfy the six ACGME competency requirements in clinical
                        or classroom environments (i.e., knowledge, patient care,
                        practice-based learning and improvement, communication
                        and interpersonal relationships, professionalism and
                        systems-based practice).
                •       Qualify for and pass the American Board of Obstetrics and
                        Gynecology examination (written and oral),
                •       Demonstrate sound medical judgment in clinical practice,
                •       Demonstrate outstanding surgical and technical skills in
                        obstetrics and gynecology,
                •       Show respect and sensitivity to the values and needs of
                        others.
                •       Interact effectively with patients, peers, families and the
                        health care team.
                                                                                               18
             •       Compete successfully for entry into OB/GYN fellowships in
                     Maternal Fetal Medicine, Reproductive Endocrinology and
                     Infertility, Urogynecology and Pelvic Reconstructive Surgery,
                     Gynecologic Oncology, or Reproductive Genetics.
             .




2.   Does the program currently have individual residents in tracks for training beyond six
     months but less than or equal to twelve months? Yes or o.
             No.

3.   Discuss who appoints the Program Director and the length of the Program Director's tenure.
     If Program Director is not the chair, discuss the authority of the Program Director to effect
     change in the program.


     The Chair recommends to the Graduate Medical Education
     Committee and the Designated Institutional Official (DIO) his/her
     choice for Program Director. The GMEC then votes on this
     nomination and if passed, the Program Director is then appointed by
     the DIO. The Chair reviews and renews this appointment on an
     annual basis. The Chairman has vested the Program Director with
     the authority to make changes in the program that are appropriate to
     the RRC requirements for the curriculum as well as to ensure that
     high quality, comprehensive resident education is of primary
     consideration. The Program Director’s position and job description
     remain separate from the Chair’s responsibilities. However, the current
     Chair’s strong personal support and past experience in medical education
     provide a resource, foundation, and administrative pathway that facilitate
     implementation or reinforcement of policies and procedures. The
     necessary authority to achieve faculty and attending staff cooperation occurs
     through earned respect of his administrative role as Program Director, and
     support from the Chair as needed. Thus, the Program Director works
     directly with Division Directors and faculty on residency issues that need
     attention. He also heads the Resident Education Committee where
     consult and advice are received for specific situations. Additionally, the
     Department provides trainees with a policy and procedure manual when
     they enter the program that describes the Program Director’s authority in the
     areas of promotion and disciplinary action. A current policy and procedure
     manual is posted on the resident webpage.
                                                                                                    19
4.   List in tabular form by rotation and by year the resident call schedule, including free time
     away from the program.

     See tables on following page.

     Is there one day out of seven free from program duties?     YES ( X ) NO ( )
                                                                                                                                                                       20

A4: Rotational Call Schedule


PGY-4      July         August     September      October        November      December      January        February       March            April            May      June
Rotation   Float        OB-H       OB-H           GYN-H          HV            AMB           Oncology       HV             GYN-H            Gyn-             OB-      Oncology
                                                                                                                                            Saginaw          H
Call       5 shifts     Five       Five 12        Four 12        Four 12       Four 12       Four 12        Four 12        Four 12          three 12         Five     Four 12
           per week,    12         hour shifts    hour shifts    hour shifts   hour shifts   hour shifts    hour shifts    hour shifts      hour shifts      12       hour shifts
           Sunday       hour       per week       per month      per month     per month     per month      per month      per month        per month        hour     per month
           thru         shifts                                                                                                                               shifts
           Thursday,    per                                                                                                                                  per
           6PM to       week                                                                                                                                 week
           7AM
Time off   Friday       2 days     2 days off Minimum of Minimum of            Minimum of    Minimum of     Minimum of     Minimum of       Minimum of       2        Minimum of
           AM to        off per    per week   four 24        four 24           four 24       four 24        four 24        four 24          four 24          days     four 24
           Sunday       week                  consecutive consecutive          consecutive   consecutive    consecutive    consecutive      consecutive      off      consecutive
           PM                                 hours days     hours days        hours days    hours days     hours days     hours days       hours days       per      hours days
                                              per month      per month         per month     per month      per month      per month        per month        week     per month
Vacation may be taken on any rotation except night float and Hutzel OB
One week of conference in June


PGY-3      July      August         September      October       November      December      January       February       March          April            May         June
Rotation   MFM       OB-H           UROGYN         ELECTIVE      SYN-SG        GYN-SG        OB-SG         OB-H           GYN-H          OB-H             FLOAT       GENETICS
Call        Four      Five 12       Four 12         Four 12      Four 12       Four 12       Four 12        Five 12       Four 12         Five 12         Five 12     Four 12
           or five   hour shifts    hour shifts    hour shifts   hour shifts   hour shifts   hour shifts   hour shifts    hour           hour shifts      hour        hour shifts
           12        per week       per month      per month     per month     per month     per month     per week       shifts per     per week         shifts      per month
           hour                                                                                                           month                           per
           shifts                                                                                                                                         week
           per
           month
Time off    2        Minimum of     2 days off      2 days off    2 days off    2 days off    2 days off   Minimum of      2 days        Minimum of       Friday       2 days off
           days      four 24        per week       per week      per week      per week      per week      four 24        off per        four 24          AM to       per week
           off       consecutive                                                                           consecutive    week           consecutive      Sunday
           per       hours days                                                                            hours days                    hours days       PM
           week      per month                                                                             per month                     per month


Vacation may be taken on any rotation except night float and Hutzel OB
                                                                                                                                                                 21

A4: Rotational Call Schedule

PGY-2      July           August         September     October       November       December        January        February   March     April     May         June
Rotation    MFM           Endocrine      OB-H          OB-H          GYN-H          LRC             OB-SG          Family     GYN-      ONC       FLOAT       OB-H
                                                                                                                   Planning   H
Call       Four or five   Four or five   Five 12       Five 12       Four or five    5 shifts per   Four or five   Four or     Four      Four      5 shifts   Five 12
           12 hour        12 hour        hour shifts   hour shifts   12 hour        week,           12 hour        five 12    or five   or five   per week,   hour shifts
           shifts per     shifts per     per week      per week      shifts per     Sunday          shifts per     hour       12        12        Sunday      per week
           month          month                                      month          thru            month          shifts     hour      hour      thru
                                                                                    Thursday,                      per        shifts    shifts    Thursday,
                                                                                    6PM to                         month      per       per       6PM to
                                                                                    7AM                                       month     month     7AM
Time off  Minimum of Minimum of Minimum of              Minimum      Minimum of     Minimum of      Minimum of     2 days     2         2         Friday      Minimum of
          four 24       four 24        four 24         of four 24    four 24        four 24         four 24        off per    days      days      AM to       four 24
          consecutive consecutive consecutive consecutive consecutive               consecutive     consecutive    week       off per   off       Sunday      consecutive
          hours days    hours days     hours days      hours days    hours days     hours days      hours days                week      per       PM          hours days
          per month     per month      per month       per month     per month      per month       per month                           week                  per month
Vacation may be taken on any rotation except night float, Hutzel OB and LRC
                                                                                                                                                               22

PGY-1      July      August         Septembe      October        November        December       January        February   March        April     May      June
                                    r
Rotation   OB-H      GENETICS       GYN-SG        OB-H           FLOAT           U/S            OB-SG          GYN-SG     GYN-H        OB-H      GYN-     ER
                                                                                                                                                 H
Call        Five     Four or five   Four or        Five 12        5 shifts per   Four or five   Four or five   Four or    Four or       Five     Four     Twenty 12
           12 hour   12 hour        five 12       hour shifts    week,           12 hour        12 hour        five 12    five 12      12        or       hour shifts
           shifts    shifts per     hour shifts   per week       Sunday thru     shifts per     shifts per     hour       hour         hour      five     per month
           per       month          per month                    Thursday,       month          month          shifts     shifts per   shifts    12
           week                                                  6PM to 7AM                                    per        month        per       hour
                                                                                                               month                   week      shifts
                                                                                                                                                 per
                                                                                                                                                 mont
                                                                                                                                                 h
Time off   Minimu    Minimum of     Minimum       Minimum of      Friday AM      Minimum of     Minimum of     Minimu     Minimum      Minimu    Mini      Minimum
           m of      four 24        of four 24    four 24        to Sunday       four 24        four 24        m of       of four      m of      mum      of four 24
           four 24   consecutive    consecutiv    consecutive    PM              consecutive    consecutiv     four 24    24           four 24   of       consecutiv
           consec    hours days     e hours       hours days                     hours days     e hours        consecut   consecuti    consec    four     e hours
           utive     per month      days per      per month                      per month      days per       ive        ve hours     utive     24       days per
           hours                    month                                                       month          hours      days per     hours     cons     month
           days                                                                                                days per   month        days      ecuti
           per                                                                                                 month                   per       ve
           month                                                                                                                       month     hours
                                                                                                                                                 days
                                                                                                                                                 per
                                                                                                                                                 mont
                                                                                                                                                 h
Vacation may be taken on any rotation except night float and Hutzel OB
                                                                                        23
5.   How do you accommodate for the impact of vacation, illnesses, and leaves of absence on
     residents?

We utilize Guidelines from the Accreditation Council of Graduate Medical
Education, the Graduate Medical Education policies of the Detroit Medical
Center, and the Department of Obstetrics and Gynecology Resident Policy
and Procedure Manual to handle vacations, illnesses and leaves of absence.
We consider the entire schedule after individual requests are submitted.
Vacation requests typically consist of a minimum of one-week time blocks
rather than shorter intervals. Vacation requests are submitted for the entire
academic calendar year. This provides us with a long-range plan that
improves our ability to accommodate unforeseen illnesses, leaves of absence
and enhances equitable distribution of residents in their rotation assignments.
(Residents are not permitted to take vacations while they are assigned to
night float, LRC, or Hutzel OB. They can request vacation time in any other
rotation.) Residents who take a vacation in a monthly rotation block are not
given “extra call” during the month they take their vacation to even out the
amount of calls among their team members. In the event of illness or leave of
absence, no resident can be reassigned unless it is approved by the Program
Director or the Associate Program Director. It is our policy not to “pull”
residents from their rotations to cover services, except under extreme
circumstances.
6.   Explain the rationale for the use of any participating institutions.


     Hutzel Women’s Hospital serves as the primary, participating teaching
     institution. Sinai-Grace Hospital (SGH), Huron Valley-Sinai Hospital
     (HVSH), Detroit Receiving Hospital (DRH) and Harper University Hospital
     are four other participating institutions from our sponsoring institution,
     Wayne State University, through the Detroit Medical Center/ Wayne State
     University (DMC/WSU) consortium. These four sites provide specific
     learning experiences within our multi-institutional program of GME.
     Synergy Medical Educational Alliance is a community teaching hospital
     system in Saginaw, Michigan.

     Hutzel Women’s Hospital is the primary site for resident training with the
     largest concentration of both ambulatory and in-patient women’s care in
     the Detroit Medical Center (DMC). It is strategically located in the heart of
     the DMC central campus. Hutzel Women’s Hospital provides the majority
     of OB/GYN care for uninsured and underinsured women in Southeast
     Michigan. This care is provided at the hospital and the clinics next door to
     the hospital at the University Health Center (UHC). Hutzel Women’s
     Hospital is home to the NIH/NICHD Intramural Research Branch, which is
     also called the Perinatalogy Research Branch (PRB). The PRB is based
     out of Hutzel Women’s Hospital and Wayne State University due to the
     patient volume and patient population treated here.
     .
                                                                                   24
     Sinai-Grace Hospital is a community hospital located in Northwest Detroit,
     approximately nine miles from Hutzel Women’s Hospital. Our faculty
     educates residents at this site. The OB/GYN Department primarily
     consists of a large staff of private practitioners and includes a significant
     number of physicians. The patient population at Sinai-Grace is
     approximately 75 percent private and 25 percent staff. Many of these
     physicians trained in the area or at Hutzel Women’s Hospital. There are
     also five full time faculty members with different amounts of time dedicated
     to support the residency.

     Huron Valley-Sinai Hospital is located in Oakland County in a rapidly
     growing community. The gynecologic service at Huron Valley-Sinai
     consists entirely of private patients. A group of private practitioners
     services this site. The site functions to train our PGY4 residents further in
     gynecologic surgery. It provides additional exposure to a private practice
     environment.

     Detroit Receiving Hospital (DRH) Emergency Department physicians
     educate our PGY1 residents in emergency medicine. DRH has been
     designated a level one trauma center.

     Synergy Medical Educational Alliance is a community-based teaching
     hospital whose primary affiliation is with Michigan State University School
     of Medicine. A core of faculty run the OB/GYN program at this site, in
     addition to care given by a large number of private practice physicians.
     Our fourth year residents will rotate for one month at this facility and
     perform gynecologic surgery with an emphasis on vaginal hysterectomies.


7.   Describe the educational exposure to and supervision of the following (include ambulatory
     experience where appropriate): Limit descriptions to: 1. structure of learning opportunity,
     i.e. rotations, 2. teaching rounds and conferences, and 3. provision of supervision, (Limit
     of 20 pages total and #12 font for answers to #7.)
     a.        Normal obstetrics


     Residents are provided a broad experience in normal obstetrics at Hutzel
     Women’s and Sinai-Grace Hospitals. Currently, the obstetrical volume is
     over 8,000 deliveries between the two institutions. The resident physician
     as primary physician provides antenatal, intrapartum, and postpartum care
     with faculty supervision to over 3,000 staff patients.


     Hutzel Women’s Hospital

     1. Structure of learning opportunity
     Residents provide prenatal care to patients at the University Health
     Center. This clinic contributes over 3,000 patients to the delivery pool for
                                                                            25
the residency program. Care for this group of women is provided in
resident continuity clinics and by a large contingent of midlevel providers
who see approximately 50 percent of normal obstetrical visits at the
University Health Center. The use of midlevel providers has allowed
residents to have an ambulatory experience that does not become
overwhelming in obstetrical volume.

Residents see pregnant women less than 16 weeks gestation in the
Emergency Department (ED) at Hutzel Women’s Hospital. They evaluate
patients presenting after 16 weeks pregnancy with urgent or emergent
complaints in the Labor Reception Area (LRC), a dedicated obstetrical
triage unit located on Labor and Delivery. Residents learn and refine
ambulatory obstetrical triage skills when assigned here. Nurse
Practitioners and Midwives cover this unit on weekdays and some
weekends. A PGY2 is assigned to work with the night team to cover the
unit as a formal rotation. Members of the residency take call on weekends
at this site. In addition to obstetrical triage, the LRC affords a large amount
of primary care encounters. Any pregnant patient, unless involved with
trauma or seriously unstable is evaluated in the LRC.

Three resident teams form the Obstetrical service: two teams for day labor
and delivery (L&D) and one night team. Teams are composed of four
residents representing each postgraduate year. L&D coverage is provided
in twelve-hour shifts with four to seven shifts each week. The night team
covers L&D seven consecutive nights, the day team’s alternate weekday
coverage. Members of the obstetrical team are also responsible for
rounding on postpartum patients they have delivered.
2. Teaching rounds and conferences
Daily morning and evening ”board turnover” rounds are conducted by the
faculty at the change of shifts on L&D. All aspects of obstetrical care are
discussed during board turnover from basic prenatal care, to the
pathophysiology of labor, and managing complex obstetrical conditions.

Board turnover is followed by 8:00 a.m. obstetrical conferences for one
hour on Mondays, Wednesdays, Thursdays and Fridays. Monday is the
ultrasound conference. This CME conference is attended by residents and
students on OB, faculty and fellows of the MFM division, members of the
NIH Perinatal Research Branch and technicians of the ultrasound unit.
Participants review tapes of ultrasounds and discuss findings. On
Wednesday morning sessions, interesting fetal monitor strips from the
previous week are reviewed. They discuss and critique patients’
intrapartum management and talk about alternate courses of
management. Residents, MFM attendings and fellows attend this
conference. One of the MFM attendings or fellows supervises the
conference. Thursday is a combined Pediatrics/OB/GYN conference.
                                                                          26
Members appraise two to four cases each week. They discuss and
critically assess all aspects of care and management from prenatal care to
management on L&D and in the nursery. One topic is then presented in an
interactive format. Both Obstetric and Pediatric attendings, fellows,
residents and students attend this conference. Friday mornings pertain to
MFM conferences. The MFM attending that month supervises these
conferences. This group discusses high risk cases that present special
problems.. A resident prepares and formally presents an MFM topic as
part of this weekly conference.

Teaching on L&D is conducted through an organized team approach with
assigned responsibilities for the team members. PGY1 residents learn the
basic principles of labor and delivery with management of laboring
patients, including the interpretation and management of electronic fetal
heart rate monitoring, and the evaluation and care of the postpartum
patient. Surgical skills for primary cesarean deliveries are learned and
then further refined during surgery performed with faculty, attendings or
PGY4 residents with faculty supervision. PGY2 residents manage
complex and high risk laboring patients. Second year residents perform
the more technically difficult cesarean deliveries. PGY3 residents provide
the management for the patients on L&D.A major part of this rotation for
third year residents focuses upon obtaining the skills to supervise and
delegate tasks to the members of the team properly and safely. PGY4
residents provide oversight to the function of the unit while taking primary
responsibility for patients admitted to the Maternal Special Care Unit.
These residents function as a junior attending on surgeries performed for
non-private patients. A member of the OB/GYN faculty supervises all of
these surgeries. In addition, all residents supervise and teach medical
students as part of their obstetrical rotation responsibilities.


3.   Provision of supervision

A faculty members staffs each OB/GYN departmental continuity clinic
with no more then four residents at any session. Pregnant women seen in
the Emergency Department are evaluated by a resident member of the
gynecology service under the supervision of the gynecology attending
physician who is present in the hospital and on service that day. On week
nights, the night float team evaluates these patients and the case is
reviewed with the in-house, on call fellow and attending. On the
weekends, the on call team will evaluate the patient and review the case
with the in-house, on call fellow and attending.

Residents who see women in the LRC on weekdays present their cases to
the attending physician prior to their discharge. At night and on weekends
the resident presents all cases to the on call fellow or attending physician.
                                                                           27

Four members of the Maternal Fetal Medicine (MFM) faculty and one
member of the gynecology division supervise intrapartum care during the
day with on-going, consistent oversight. At night and on weekends,
members of the OB/GYN department along with a fellow provide staffing
on L&D.

A MFM Division member is assigned to each delivery team with team
rounds scheduled and held daily. These rounds facilitate the discussion of
the appropriate management of postpartum patients and their puerperal
problems. Continuity of postpartum care is fostered by assigning
readmitted patients to the team which delivered the patient whenever
possible. This method of follow-up increases the resident’s ability to
analyze the care given and provides feedback about modifications that
could improve outcomes in the future.



. .
Sinai-Grace Hospital

1. Structure of learning opportunity
Residents encounter a different obstetrical experience at Sinai-Grace
Hospital in comparison to Hutzel Women’s Hospital. Here approximately
80percent of the obstetrical patients are private and the other 20percent
are hospital clinic patients. Six residents participate in continuity clinics
based at Sinai-Grace Hospital to provide antepartum care for these clinic
patients. Currently, the team consists of a PGY3, PGY2 and a PGY1
resident. Often, a family medicine resident rotates to this team as well.
Call taken at Sinai-Grace Hospital consists of a PGY2 and PGY3 resident
as a night float team during the week. On the weekends, the team
consists of a PGY1 plus either a PGY2 or PGY3. They cover the L & D
and GYN services. Physician assistants provide coverage and care of
low-risk obstetrical patients during the day, and provide Monday through
Friday coverage of the triage area.

2. Teaching rounds and conferences
Teaching rounds occur during morning report held daily at 7:00 a.m.
These rounds combine patients receiving obstetrics and gynecology care.
Following morning report, rounds are conducted on all staff patients.
There are scheduled formal presentations every Wednesday at 8:00 a.m.
with the exception of the first Wednesday of each month when the
Department Service Meeting is held. The Wednesday conferences
consist of a gynecology conference, a combined pediatrics/neonatology
and obstetrics conference. The meeting addresses an interesting case
from that month in conjunction with an M&M conference. If there is a fifth
                                                                           28
Wednesday in the month, a special presentation is given on new
innovations in our discipline.




3. Provision of supervision
Dr. Karoline Puder, Division of Maternal Fetal Medicine, is the site director
for the Northwest campus. She provides primary supervision of residency
teaching activities at this site. Dr. George Shade, Chief of Obstetrics and
Gynecology at Sinai-Grace Hospital supports all educational efforts on the
campus. He serves as a resource for the residents and Dr. Puder. There
are three other faculty (Drs. Gonik, Baker and Sudakin) at Sinai-Grace
Hospital who provide staffing in the continuity clinics and teaching rounds.

Members of the Department of OB/GYN provide supervision on L&D
during weekdays and by private practice physicians who are in house on
nights and weekends. These physicians provide instruction and education
as they work with the residents in the intrapartum and postpartum care of
their patients. All patients are discussed with the private attending and/or
the faculty staff covering the unit.




b.     Instruction of patients about breast feeding

There are multiple opportunities within each rotation to assist women in
making an informed decision to attempt lactation as the sole or partial
source of nutrition for their newborns. Issues relating to the care of the
lactating woman, and skills for problem solving encountered by lactating
women are discussed, taught and developed for practice in postpartum
rounds on all obstetrical services. At Sinai-Grace Hospital, we have a
Certified Lactation Consultant who holds daily classes and conducts
personal rounds on all breast-feeding mothers. The high percentage of
women in our population with underlying medical conditions who require
medications necessitate an understanding of the safety and effects of
pharmaceuticals in relationship to breast feeding. The resident education
lecture series also contains a module on the role of the obstetrician in
breast-feeding. In addition, residents may team with an RN who has
received a certificate in lactation consultation as a resource to the
postpartum care team to deliver optimal quality care in this area.
Residents receive supervision from attending physicians and chief
residents. Residents are expected to demonstrate comprehension of the
key principles of breast training during this rotation.
                                                                        29



c.     High risk obstetrics

Hutzel Women’s Hospital

1. Structure of learning opportunity
On the central campus, the MFM team is composed of three residents
(PGY1,2,3) on a month long rotation at Hutzel Hospital. The MFM team is
responsible for the management of all antepartum admissions. The
resident is exposed to all aspects of maternal-fetal medicine by several
different avenues while on this rotation. This includes four, half day
sessions where residents provide ambulatory high risk obstetrical care in
the University Health Center (UHC), antenatal fetal surveillance, genetic
counseling, ultrasound scanning, invasive diagnostic procedures,
intensive care, and intrapartum care. The residents on MFM also attend a
weekly HIV clinic and a substance abuse clinic (Eleonore Hutzel Recovery
Center). These patients typically present complex, multiple health, and
socioeconomic issues. Dealing with these issues gives them experiences
and skills that combine all of the competencies in teaching environment--
systems based practice, professionalism, patient care, medical
knowledge, practice-based learning and improvement, and communication
and interpersonal relationships can be taught and applied with one patient
visit. The residents on the high risk service also attend the NIH Perinatal
Research Branch (PRB) antepartum clinic as part of their rotation. This
clinic is an arm of the PRB at Hutzel and the vast majority of women seen
in these specialty clinics are at increased risk for preterm labor. The
residents become highly skilled at performing vaginal probe ultrasound to
measure cervical length during this rotation. The residents are exposed to
and participate in performing numerous amniocentesis procedures due to
these patients’ medical problems.

The MFM service performs most of the antenatal surgery identified at the
University Health Clinic, including cervical cerclages and exploratory
laparotomies. The team also supplies perinatology consultations for the
central campus of the medical center.


2. Teaching rounds and conferences
The MFM team attends teaching rounds daily from 7:00 to 8:00 a.m. with
their assigned faculty attending and fellow from the MFM Division. The
MFM team is then expected to attend the obstetric conference from 8:00
to 9:00 a.m. on Monday, Wednesday, Thursday and Friday (previously
described in Section A7.2). The MFM team prepares and presents the
High Risk conference on Fridays. A formal case presentation made at the
                                                                          30
end of the month by a member of the MFM team typically highlights an
interesting case from that time period.

3.   Provision of supervision
Each month there is an MFM faculty member and fellow assigned to the
group of residents. These physicians round daily with the residents on
high risk and supervise the running of MFM service that month.

An MFM faculty member and an MFM fellow staff the High Risk Clinic at
UHC. Dr. Theodore Jones, chief of the MFM division, staffs the HIV clinic.
Dr. Carl Christensen, who is certified in substance abuse, staffs the
substance abuse clinic. The PRB clinics are supervised by Dr. Lori Billis, a
member of the gynecology division and members of the MFM division.

Sinai-Grace

1. Structure of learning opportunity
The Northwest campus MFM service utilizes the PGY2 resident to provide
coverage for the in-patient service at Sinai-Grace Hospital. Patients
initially are admitted by private physicians who then request the
consultative services of the MFM staff. These patients are evaluated by
the resident team and presented to the MFM attending. There is a weekly
High Risk Clinic session in which high risk pregnant patients are evaluated
and given prenatal care as well as postpartum follow-up.




2. Teaching rounds and conferences
All consults are seen by the resident followed by a case presentation and
then bedside rounds. Weekly Perinatal Conferences are organized by the
team and emphasize clinical correlation of recent cases with literature
review and discussion.

3. Provision of supervision
The high risk service is supervised by the MFM faculty (Drs. Puder and
Gonik). Every consult is seen and discussed with the resident. Drs. Puder
and Gonik also staff the high risk clinic and each patient is discussed with
one of them.




d.      Immediate care of the newborn, including resuscitation

First year residents complete the Neonatal Resuscitation Course for
certification during the orientation week prior to starting their first
postgraduate year. Residents work closely with the neonatal resuscitation
                                                                           31
team. They are encouraged to support and if the occasion should arise,
participate in neonatal resuscitations during obstetrical rotations at Hutzel
Women’s and Sinai-Grace Hospitals. On-going education about
resuscitation and short- and long-term outcomes are acquired from once
weekly Perinatal-Neonatal Conferences. These conferences represent a
joint effort between the Division of Neonatology/Department of Pediatrics
and the Division of Maternal Fetal Medicine/Department of Obstetrics and
Gynecology. Senior Pediatrics residents and fellows provide supervision
of resuscitations on Labor and Delivery.



e.      Operative gynecology

Hutzel Women’s Hospital

1. Structure of learning opportunity
The Gynecologic service consists of four residents, one from each year.
In the PGY1 year, emphasis is placed upon learning laparoscopic
procedures and ambulatory vaginal procedures. There are occasional
opportunities to second assist on abdominal and more complex vaginal
surgeries. The PGY1 also is responsible for the initial evaluation of
consults from the emergency room as well as for the initial evaluation of
problems on the Gyn floor. At the end of the rotation, PGY1 residents
perform the initial evaluation of consults from the other services at Harper
University Hospital and from Detroit Receiving Hospital (DRH) The PGY1
resident attends continuity clinics, but does not have a schedule until their
PGY3 year. They assist and observe other residents in the clinic for one
half-day per week. The PGY1 also attends Colposcopy clinic for one to
three half days per week. At Colposcopy clinic they learn how to perform
Colposcopy, conduct cervical, vaginal and vulvar biopsies and handle
endocervical curettages. .
PGY2 residents have opportunities to learn the proper evaluation and
management of gynecologic problems of staff and private patients. Staff
patients are admitted for surgery from the emergency room or continuity
clinic. Responsibility in the operating room is broadened to include a
wider range of abdominal surgery and operative laparoscopy. PGY2
residents are responsible for the evaluation of consults from Harper
University Hospital and Detroit Receiving Hospital. These consults are
then reviewed with a senior resident and the staff physician.
PGY3 residents are responsible for the evaluation and management of
more clinically challenging patients. Residents gain knowledge and skills
about the logistics of planning surgery and ordering of associated ancillary
services at this time. Responsibility in the OR is increased with the
expectation that a resident in this year of training perform most major
                                                                           32
uncomplicated gynecologic surgeries.
PGY4 residents assume overall responsibility for the patients scheduled
for surgery through the clinic and are instrumental in the distribution and
assignment of surgery coverage in the OR. As such, they are required to
develop a keen awareness of the capabilities of the more junior resident
surgeons, as well as the individual needs of the attending surgeons
based upon the complexity of the surgery. Their presence is expected
when challenging cases are performed. Patients undergoing elective
surgery are, if possible, presented the preceding Friday during the
preoperative conference.


2. Teaching rounds and conferences
Teaching rounds occur daily from 7:00 a.m. to 8:00 a.m. at Morning
Report. Each patient on the service is presented and discussed. In
addition, bedside rounds of all staff patients, private faculty patients and
consenting private attending patients focus upon patient evaluation with
special attention to interesting or problematic care issues. Topics are
discussed based on types of cases admitted or upon previous
assignments assigned by attendings. There is a Colposcopy Conference
every Wednesday morning from 7:30 to 8:30 a.m. This conference utilizes
a web-based program from the Colposcopy clinic, developed by our own
department where each patient’s digital Colposcopy picture is compared
to her cytology and pathology results. Dr Muji Husain, a cytopathologist
from the Department of Pathology, has invested a large amount of effort in
preparing cases for resident education and has presented this unique
teaching technique at national meetings. Management is then
determined. Ten to twelve faculty members usually attend the Colposcopy
Conference from the Gynecology Division and the Pathology Department.
The Friday conference topic usually consists of a review of all current
patients with ectopic pregnancies and a preoperative presentation of
women scheduled for surgery the next week from the UHC clinic.



3. Provision of supervision
Supervision occurs by members of the Gynecology Division. Faculty
members alternate by covering the service for a week at a time. The
assigned faculty member instructs the daily teaching rounds, supervises
weekend rounds, as well as reviews all consults. Under ideal conditions,
patients seen in the Emergency Department or hospital consults are
handled by junior residents. Junior residents subsequently present these
cases to a senior resident and then to the gyn attending. Often it is just the
junior or senior resident presenting to the gyn faculty member covering the
gyn service that day. Every patient undergoing colposcopy is seen with
either Dr. Kmak or Dr. Christensen, who staff the colposcopy clinic.
                                                                            33

Different Gyn faculty staff the OR daily. These faculty members supervise
residents for all staff cases. The level of supervision varies with each level
of training and on individual resident abilities. Senior residents, under the
supervision of faculty, are responsible for teaching appropriate procedures
to Junior residents. This provides additional educational opportunities for
the senior residents. The amount of resident supervision provided by
faculty complies with all Medicare requirements.


Sinai-Grace Hospital
1. Structure of learning opportunity

The gynecology team at Sinai-Grace Hospital consists of three residents,
a PGY1,2 and 3. The vast majority of gynecologic surgeries are performed
by private attendings. Cases are assigned by the PGY3, who functions as
the chief resident on this service. This is valuable experience for PGY3’s
in obtaining skills for functioning as a chief resident at Hutzel in their PGY4
year with a large indigent patient population. There is one faculty assigned
to cover L&D and gynecology during the day. At night and on weekends,
there is attending in house coverage.
2. Teaching rounds and conferences
Morning report occurs each morning from 7:00 to 8:00 a.m. Different
assigned topics are presented by residents throughout the week. Bedside
rounds occur after morning report with the faculty on call that day.


3. Provision of supervision
There are five, full time faculty members at Sinai-Grace who supervise the
gynecologic as well as obstetric rotations. These Sinai-Grace faculty
supervise morning report and the OB/GYN service during the day. At night
and on weekends, the gynecology service is covered by a night float call
team or weekend call coverage. These residents are supervised by the
attending that is on in-house call.


Huron Valley-Sinai
1. Structure of learning opportunity

Fourth year residents rotate at Huron Valley for two month blocks
performing gynecologic surgery. A large number of vaginal and urologic
surgeries are performed at this private practice hospital. Most of the
private practice physicians have received their training at Detroit Medical
Center programs and are very receptive to training our residents. This is
purely a surgical rotation. No call is taken at Huron Valley and there is no
obstetrical coverage provided by the residents.
                                                                         34
2. Teaching rounds and conferences
Residents are expected to attend Grand Rounds and Resident lectures.
Residents round on post-operative patients and non-surgical gynecologic
patients.
3.   Provision of supervision
Dr. Mehmat Bayrum and Dr. David Calver provide supervision. Dr.
Bayrum serves as the site director and is responsible for resident’s
evaluations at the end of the rotation. Each case is scrubbed with a private
attending and the attendings provide the majority of supervision at this
facility.



Synergy Medical Education Alliance
1. Structure of learning opportunity

Beginning July 1, 2007 fourth year residents will do a one month,
extramural rotation on the gynecology service at the Synergy Medical
Educational Alliance Hospital system. During the rotation it is expected
that each resident will perform seven to ten vaginal hysterectomies, along
with other gynecologic surgeries appropriate for a senior resident. The
vast majority of the patients are private patients. A group of private
physicians recently opened an ambulatory surgery center and the program
at Synergy Medical is not able to provide resident coverage for these
cases. These additional patients provide new, supervised training
opportunities for our residents in gynecologic surgeries. This technique of
rotating residents to outside sites for the purpose of increasing their
surgical exposure was recently recommended by RRC personnel at the
annual APGO/CREOG meeting (2007).


2. Teaching rounds and conferences
Morning report is held daily with an hour of protected time. Each day of the
week is devoted to a different OB/GYN specialty. The majority of lectures
are given by Synergy Medical full time faculty with residents assigned
topics throughout the month.


3. Provision of supervision
Full time faculty members will supervise the resident at this facility. Dr.
Thomas Raskauskas is the Program Director and will be the supervisor of
the residents on site. Full time faculty staff L&D and the gynecologic
service on weekdays for emergencies and patients who present without
an attending physician. They provide supervision for the residents in
these situations.
                                                                          35




f.    Gynecologic malignancies

The Division of Gynecologic Oncology runs comprehensive outpatient,
inpatient and surgical services. The resident rotates on the service for a
total of three months, with one month occurring at the PGY2 level to allow
early exposure to the subspecialty and two consecutive months at the
PGY4 level. The second year resident gains experience in the work-up
and the supportive care of chemotherapy patients; evaluation of patients
presenting to the Emergency Room; and management of postoperative
complications. The PGY2 resident also performs minor surgical
procedures (e.g., laser ablation) and some major surgical cases. The
PGY4 resident is the first assistant in all major oncology cases,
constituting the majority of surgical oncology training offered by the
Oncology Division. The PGY4 resident supervises the junior residents,
students and rotators on the service. During the rotation, the oncology
residents attend two to three outpatient oncology clinic sessions per week.

Rounds on the inpatient service begin usually at 7:00 a.m. daily and
include discussion of patient specific problems, as well as general topics
regarding gynecologic cancers. In addition, the division has weekly
lectures for two hours on Tuesday afternoons. These lectures cover all
gynecologic oncology topics during the course of the year. Each resident
rotating on the service is required to attend this lecture series. Tumor
Board is held on the first, third and fifth Tuesday of the month and is
attended by two to three gynecologic oncologists, a radiation oncologist,
one or two gynecologic pathologists and members of the Cancer Genetics
Department. Resident’s present specific cases and a comprehensive
discussion follows by the entire group expanding on diagnosis, staging
and management of various gynecologic cancers.

In the past few years, the Division has been very active initiating a number
of research projects. Some of these investigations involve collaboration
with other departments and investigators. Interested residents are
encouraged to take advantage of available opportunities and are
mentored through well defined projects targeted to answer specific
questions. Their research findings are presented at the yearly
departmental Resident Research Day held in March. In addition, abstracts
are submitted to national meetings. Residents whose abstracts are
accepted for local and national presentations are sponsored to attend
these meetings.

The Division of Gynecologic Oncology provides evaluation and care of
                                                                                   36
patients throughout the metropolitan area. There is a continued trend,
within the practice of academic Gynecologic Oncology, for the patients to
receive their surgery and care in the community hospitals of the referring
physicians. In the past two years, the resulting decline in the number of
surgical cases referred to the university hospitals has resulted in a
decreased exposure of the residents to radical gynecologic surgical
procedures. The Division members and the Department leadership
recognize the impact their practice patterns may have on resident
education, particularly the volume of surgery on the Central campus. The
Division has made several efforts to address these concerns. They have
added two faculty members (one gynecologic oncologist and one general
gynecologist, who will function as the resident education liaison to the
program). There is also an increased awareness that surgeries for
invasive cancer need to be done on campus. The Residency Program
administration views these efforts as examples to further their commitment
to resident education and patient care.




g.     Infertility and endocrinopathies

There is usually a PGY2 and PGY4 on the Reproductive Endocrinology
and Infertility (REI) service. Beginning July 1, 2007, the PGY4 will spend
half time at the REI clinic and the other half at doing primary care and
menopause.. Ample exposure to common infertility and endocrine
problems is afforded residents while on the Reproductive Endocrinology &
Infertility (REI) service. Residents see patients for outpatient surgery with
supervising faculty. They discuss the diagnosis, evaluation and proposed
management. The faculty supervises the pre-operative, intra-operative
and post-operative care of the patients. The recent addition of the Berry
Surgical Center (an outpatient site) has afforded increased surgical
experience in endocrinology procedures. A review of the residency’s
surgical experience opportunities shows that in addition to the REI faculty,
the private attendings provide a wide experience for the resident in
operative hysteroscopies, operative laparoscopies, and intra-abdominal
laser procedures.
When surgery is performed with REI fellows present, the resident
becomes the first assistant with the fellow while the faculty attending
supervises. In addition, residents have the opportunity to see patients in
clinic with the faculty at the Southfield facility five days/week. It is in this
setting that the resident is exposed to infertility issues and common
problems in Reproductive Endocrinology. The residents perform a large
number of transvaginal ultrasounds and sonohysterograms during their
rotation. The residents also have the opportunity to observe or conduct
laboratory procedures in the Endocrine, Andrology, and In Vitro
                                                                            37
Fertilization (IVF) laboratories. The residents are expected to participate in
the daily noon conference at the Southfield clinic where ovulation
induction results are reviewed and patient instructions and treatment plans
are formulated. Additionally, this working session reviews pregnancy
outcomes and management of patients in early pregnancy, as well as
providing a forum for discussion of patients with problems or
complications. The residents are also expected to participate in the
weekly IVF conference at which patient management options are
discussed for new and repeating ART patients. Residents are required to
take a pre- and post-test based on CREOG objectives to assess their
progress.
A large number of our residents seek an REI fellowship after their
residency. To help create a stronger applicant, we have altered the
rotation for these individuals. Residents may elect two months of basic
science research during their second year with one of these months
scheduled as their REI rotation. These residents are required to rotate
onto REI during the elective month in their PGY-3 year.




h.     Pathology

Pathology is part of the learning process throughout multiple points in the
curriculum. We have found the inclusion of pathology within individual
rotations to be a more effective learning strategy in comparison to the
dedicated Pathology rotation that we used several years ago. Didactic
offerings on clinical subjects include information on pathology relevant to
the topic. There are several specific examples of its integration into
learning on teaching rounds and in conferences. There is a weekly
Colposcopy conference that is conducted by the Gynecology Division
under the direction of Dr. Mujtabi Husain. Cases presented by residents
are organized weekly for presentation with review of cervical cytology and
colposcopically directed biopsies of the cervix. In accordance with the
American Society of Colposcopy and Cervical Pathology (ASCCP)
guidelines, patients being considered for cervical conization are presented
at this conference before proceeding with surgery. The Gynecologic
Oncology service presents a Tumor Board conference on a bi-weekly
basis. This interdisciplinary conference combines the expertise of the
Pathology service with the Department’s faculty and ancillary oncology
services to provide an organized discussion of best practice approaches
for patient care. Slides are shown and discussed by pathologist and
surgeons with resident participation. Both offerings are highly structured
with significant faculty input and weekly feedback about resident
performance. In Perinatology, pathology assessment occurs in
                                                                          38
conferences devoted to perinatal-neonatal subjects, such as the
Ultrasound/Genetic conference and the Perinatal-Neonatal Conference.



i.    Breast disease

The curriculum includes core lectures and discussions on breast feeding,
benign breast disease, and breast cancer. Members of the gynecology
division provide the core lectures on the diagnosis and treatment of
breast disease annually during the Resident Core Lectures. These
lectures are based on the APGO supplement publication on management
of breast disease. Additional lectures on breast disease are given during
several Grand Rounds presentations throughout a residents training. In
2007, a Grand Rounds presentation on sentinel lymph node and breast
cancer was presented by Dr. Donald Weaver, Wayne State University
Professor and Chief of Surgery. Breast disease is the focus of the annual
Resident Retreat held June 12, 2007.




j.    Urinary incontinence and pelvic floor dysfunction

The PGY3 resident is assigned to the female pelvic medicine and
reconstructive surgery rotation, under the direction of Dr Gene McNeeley.
During this time, the resident actively participates in performing multi-
channel urodynamics and office cystoscopy. The resident learns to
distinguish between genuine stress incontinence, mixed incontinence and
urge incontinence. Patients with interstitial cystitis are routinely seen
during the rotation. Residents learn to perform a complete pelvic organ
prolapse quantization and examination. They learn conservative and
surgical management techniques for pelvic organ prolapse, urinary
incontinence, and fecal incontinence. Residents are able to formulate a
systematic approach to the diagnosis and in-office evaluation/treatment of
urinary incontinence. The resident has the opportunity to participate in the
physical therapy approach to pelvic floor muscle retraining and treatment.
Residents are provided with a reading packet at the beginning of the
rotation that encompasses basic principles of female pelvic medicine and
pelvic reconstructive surgery. The PGY4 resident on the Gynecology
service is the primary operating resident surgeon, working under the direct
supervision of the Gynecology faculty. Surgical experience is designed to
combine the surgical management of anti-incontinence as well as genital
organ prolapse. The attending provides supervision by working directly
with the resident on this rotation and while the resident handles
procedures.
                                                                          39




k.     Genetic disorders
The genetics rotation consists of a one month rotation in the PGY1 and
PGY3 years. Ray Bahado-Singh, M.D supervises this rotation. Dr.
Bahado-Singh is board certified on MFM and genetics. In the PGY1 year,
residents become proficient in counseling patients with common problems
(i.e., advanced maternal age, elevated maternal serum alpha fetoprotein,
sickle cell trait) encountered frequently in the ambulatory obstetrical
population seen in the Continuity Clinic. Patient education materials have
been developed for resident use to assist with counseling patients in the
clinic setting. Patients with complex and unusual genetic conditions are
also counseled under the supervision of Maternal-Fetal Medicine
attendings in the twice weekly High Risk Clinics where patients with
certain genetic conditions are referred. The weekly ultrasound conference
allows the presentation of information regarding genetic testing and
syndromes on a regular basis. A systematic approach to the review of
common ultrasound-identified anomalies is used that is highly integrated
with information about appropriate genetic considerations and evaluations.
Information regarding serum screening and risks associated with various
teratogens, maternal medical conditions with genetic implications, and
advanced maternal age are included at almost all of the weekly ultrasound
conferences as well as discussed at the board rounds. There is an
expectation of graduated, increased familiarity with the diagnosis and
management of genetic disorders. Senior residents are expected to
display sufficient skills to guide junior residents through the appropriate
considerations for management of patients assigned to them. The weekly
Neonatal-Perinatal Conference frequently includes information on genetics
and one conference a month is devoted to patients with prenatal diagnosis
of fetal anomalies. Most recently, the NIH Perinatology Research Branch,
housed in the Department at Wayne State University, has initiated an
additional weekly conference highlighting articles in the literature or cases
of interest in collaboration with the Departments of Pathology, Radiology,
and Cardiology. These conferences include presentations by Genetic
Counselors and residents on the high risk and ultrasound rotations.
Additional information on counseling and genetic conditions is presented
on a rotating basis in the weekly Grand Rounds and the resident lecture
series.

During the month on genetics, the PGY3 reviews what was learned during
their rotation as a PGY1 in addition to adding other responsibilities. The
ability to counsel patients is emphasized and is taught by small group
discussion and role modeling from observing the attending physician and
the genetic counselors. The program allows residents the option to focus
                                                                          40
this rotation towards areas of personal interest. Many of the residents wish
to pursue fellowships in Oncology or Reproductive Endocrinology and they
pursue genetic studies in these areas. Their curriculum is planned prior to
the rotation jointly by the resident, the genetics department and the
appropriate subspecialty division.

The Perinatal Research Branch and the NIH jointly sponsor a one month
genetics and ultrasound course in July and August at the start the
academic year. The residents have lectures for 60 to 90 minutes five days
per week over a five week block. The lectures are given by leaders in the
field of genetics/ultrasound/MFM with onsite guest lecturers or via the
web. A post test is given the day after a lecture. This year, the lectures
have been expanded to six weeks.


l.    Ultrasonography, obstetric and gynecologic, with details on the faculty
      qualifications

As a PGY1, residents spend four weeks at Hutzel Women’s Hospital in the
Obstetric Imaging Division where they learn the principles of obstetrical
and gynecological scanning with the sonographers and the faculty in the
unit. The obstetric unit is staffed by board certified, Maternal-Fetal
Medicine specialists with an interest in prenatal diagnosis: Drs. Theodore
Jones, Sonia Hassan, Giancarlo Mari, Ray Bahado-Singh, and Susan
Berman. The unit is certified by the American Institute of Ultrasound in
Medicine (AIUM). All of the sonographers interacting with the residents
are Registered Diagnostic Medical Sonographers (RDMS). The residents
scan under the supervision of the sonographers and attending faculty. At
the beginning of the month, they are given materials that include a list of
rotation expectations and a log to document cases scanned during the
month. At the end of the rotation, they are expected to be able to perform
the basic components of an obstetric scan. They are tested on obstetric
scanning by a Maternal-Fetal Medicine faculty member. In addition to the
formal ultrasound training, residents gain experience doing vaginal probe
ultrasounds to measure cervical length while attending the PRB clinic on
the High Risk rotation. Training in gynecologic ultrasound is obtained by
performing scans and saline infusion sonohysterograms on the REI
rotation, on the family planning rotation and in the Emergency Room. An
attending physician or fellow supervises these procedures. A large
number of ultrasound scans are performed on the obstetrics rotation and
the LRC rotations.

Dr. Ray Bahado-Singh, Director of Obstetrical Ultrasound, organizes and
presents a weekly ultrasound conference that is attended by faculty,
residents, sonographers, and medical students. These lessons are
incorporated in the Obstetric Morning Conferences as an ongoing, didactic
CME accredited lecture series. The residents attend this conference while
                                                                            41
on the ultrasound, genetics, high risk, and general obstetric rotations.
Residents rotating on ultrasound also participate in the weekly Perinatal
Research Conference on Ultrasound. They attend the monthly
conference for the Fetal Assessment Clinic. This conference addresses
issues related to congenital anomalies and their prenatal diagnosis. In
addition, the weekly resident lecture series, and Grand Rounds
intermittently cover ultrasound-related topics.


m.    Family planning and abortion

Training in family planning begins at the PG1 level on postpartum rounds,
GYN morning report, and at the continuity clinic. Residents are instructed
on counseling patients in interval contraception and sterilization with
emphasis on the risks and benefits of each technique. The L & D service
complements this teaching with postpartum contraception counseling of
each patient that delivers. They also train the residents in obtaining
informed consent and the performance of postpartum tubal ligations.
There are several didactic presentations on contraception during the
lecture series and it is a regular, recurrent subject in the Grand Rounds
presentations. Residents and faculty have and continue to participate in
research and trials addressing advances in contraception for women’s
health.
In November, 2006 the department was awarded a $260,000 grant by the
Sarah Buffet foundation to begin a dedicated rotation for residents in
family planning and abortion training. The rotation is named after the
foundation that oversees the rotation --the Kenneth J Ryan Residency
Training Program in Family Planning and Abortion Training. It is
administered through the University of San Francisco. PGY2 residents
rotate on the service for one month. There are four, dedicated half day
clinics at the UHC where patients are seen by the family planning resident
and one or two nurse practitioners under the supervision of Drs. Kmak,
Page, Christensen and McNeeley. There is a weekly one hour didactic
session given by one of the members of the gynecology division and the
family planning resident is required to give a formal presentation to the
gynecology service attended by faculty, on service residents and medical
students on the last week of their rotation.
During this rotation, residents are offered instruction on first and second
trimester abortion techniques, including manual vacuum aspiration,
suction dilation and curettage, dilation and evacuation, and prostaglandin
induction. In addition to learning these procedures, residents learn how to
counsel women electing to have an abortion. A resident may decline to
perform abortion procedures However, they are aware of the expectation
of CREOG requirements that they are competent in the management of
abortion complications, especially septic abortions and patient counseling.
                                                                           42
Teaching of this subject occurs in Gyn morning reports as well as Grand
Rounds lectures. The family planning clinic also presents an opportunity
for teaching in primary care, as many patients utilize the clinic as their
primary care provider. Thus, residents are expected to manage topics
such as risk assessment, sexuality, depression, pelvic pain, hypertension
and cholesterol/lipid screening and management.


On the Gynecology rotation and night float/weekend call, residents
participate in the evaluation and surgical management of patients with first
trimester and early second trimester pregnancies that are diagnosed as
incomplete, missed or inevitable abortions. Each of these numerous
opportunities allows the teaching and careful review of the principles of an
elective abortion.


n.      Psychosexual counseling

Psychosexual counseling presentations from experts in the area have
been a consistent component of our Grand Rounds topics presentations.
In the past, nationally known faculty (e.g., Dr. Sandra Carson, Dr. Eric
Beber) have addressed human sexuality and sexual dysfunction issues.
In addition, Dr. Beber conducted a post-Grand Rounds seminar for
residents and fellows concerning sexual dysfunction in the infertile couple
that was interactive and very well received by the residents. In the
ambulatory patient setting, residents are encouraged to present sexual
dysfunction difficulties of their continuity patients to their attendings for
discussion and problem solving. Clinical trials on sexual dysfunction are
ongoing in the Department as part of our research endeavors. As noted
above, sexual screening/counseling is offered in several specialty clinics
where primary care is also provided. In addition, the Eleonore Hutzel
Recovery Center clinic also evaluates chronic pelvic pain patients, which
often leads to evaluation of sexual dysfunction.



o.      Critically ill patients

     1. Maternal Special Care Unit (MSCU)
     The MSCU is a five bed critical care unit for antepartum, intrapartum
     and postpartum obstetrical patients. The PGY4 residents provide
     coverage 24 hours a day with a MFM fellow and assigned faculty.
     With the assistance of MFM faculty, the resident gains experience in
     the management of severe complications of pregnancy including pre-
     eclampsia, diabetic ketoacidosis, hemorrhagic shock, septic shock,
     and cardiac decompensation. They also learn to care for pregnant
     women with respiratory failure, including managing mechanical
                                                                          43
     ventilation. There are daily patient teaching rounds and weekly case
     management conferences. Post-partum patients who require
     prolonged intubation are transferred to the Medical Intensive Care Unit,
     but are still followed by the MSCU team.


      The Intensive Care Units at Harper University Hospital manages
     critically ill gynecologic and gynecologic oncology patients. ICU
     personnel oversee the medical problems for which the patient requires
     intensive care expertise. All other conditions are managed by the
     Gynecology residents involved in that patient’s care. In addition, the
     gynecology resident taking care of that patient is actively involved in
     the ICU management of the patient while she is in the ICU and
     interacts with the ICU team while management plans and decisions are
     being planned. Supervision is provided by the gynecology attendings in
     addition to the ICU attendings and fellows.




p.      Emergency medicine

PGY1 residents are assigned to the Emergency Department (ED) at
Detroit Receiving Hospital (DRH) for one month. DRH is nationally
acknowledged as a leader in trauma care and manages one of the highest
volumes in the United States. Residents work on assigned teams with ED
residents and are supervised by ED attendings. The PGY1 residents
attend didactic lectures given by the ED. While on this rotation, they
function as part of the shift schedule of the ED. No OB/GYN
responsibilities are given to them while on this rotation. When GYN
consultations are requested in the DRH ED, members of the GYN day
team or GYN team members in the clinic provide evaluation services, not
the ED rotator. Attending physicians on duty that day provide oversight of
evaluation and management. Additional experience is obtained while
providing care at Hutzel Women’s Hospital and Sinai Grace Hospital. In
both sites, GYN team members are called when ER consultation is
requested. Junior residents provide consultative evaluation. Senior
residents impart initial supervision prior to presentation to the attending.
Attendings and fellows at Hutzel Women’s Hospital provide supervision of
consultative patient care in the ED. At Sinai-Grace Hospital, the staff
attending on-call provides oversight. Patients presenting with
gynecological problems to the Emergency Department at Hutzel Women’s
Hospital are evaluated by the PGY1 with supervision provided by the
Gynecology senior resident and the attending staff physician.
                                                                               44




q.     Primary and preventive care, including a description of the rotations and a
       description of the particulars of the experience referenced to the Program
       Requirements, Section V. A. 1. b.



PGY1 residents have a four week rotation in Emergency Room Medicine
at Detroit Receiving Hospital. During their one month in the Emergency
Department , residents see a full range of primary care problems, and are
supervised by senior emergency medicine residents and faculty. In the
PGY1 year, residents are introduced to primary care at the University
Health Center. The PGY1 is not assigned a continuity clinic, but they
assist other residents seeing patients at the UHC. The entire High Risk
team of residents see patients with Dr. Christensen in the substance
abuse clinic two, half days per week. Residents address a large number of
primary care issues during these visits, , including domestic violence,
tobacco dependence, depression, hepatitis and chronic pain in addition to
seeing patients for substance abuse.

PGY2 residents receive one month (four weeks) of primary and preventive
care during their rotation in the LRC. All pregnant women over sixteen
week’s gestation who present to the hospital, are seen in this ambulatory
setting. At least half of these visits are for medical conditions normally
seen in the office setting. PGY2 residents experience a tremendous
amount of primary care during their family planning rotation. Fifty percent
of this rotation consists of attending family planning clinics. There are a
number of primary care issues with patients seen in these clinics in
addition to their family planning issues. PGY2 residents have assigned
continuity clinics for the same half day for the academic year. Their clinics
are limited to a maximum of fifty percent obstetric visits. A large
percentage of their patients, both OB and Gyn, will present with primary
care issues due to the nature of the underserved patient population
treated at our medical center. PGY-2 residents also provide primary care
for patients on the oncology service while on the ward and in the oncology
clinics at the Karmanos Cancer Institute. Further primary care is provided
by the MFM rotation through in-house care of antenatal patients with
multiple medical problems and through the High Risk Clinics at UHC. All
patients in the High Risk clinic have at least one primary care problem and
many have three to five.

PGY3 residents are exposed to primary care through their continuity
clinics and MFM rotation. In addition the PGY3 residents manage all
primary care issues for patients on L&D. Residents see menopausal
patients with Dr. Hendrix for one day per week as part of their
                                                                      45
urogynecology rotation. These patients are scheduled with urogynecology
patients during this clinic day.

In the PGY4 year, residents have a one month ambulatory/REI rotation.
On this rotation, they spend two days per week with the REI service in the
ambulatory office setting. One day per week remains dedicated to caring
for menopausal and geriatric patients for general health maintenance at
our Women’s Health Initiative site (under the supervision of Dr. Susan
Hendrix, the Principal Investigator). One day a week, the PGY4 attends
Dr. John Malone’s office practice. Dr. Malone is a gynecologic oncologist.
His large practice provides routine and complex primary care for a number
of postmenopausal women. One day a week is also spent with Dr. Jack
Sobel, a member of the Infectious Disease Division of the Department of
Internal Medicine. Residents see patients with challenging vaginal and
vulvar disorders, along with other infectious disease abnormalities in his
office (see Section A7o). The PGY4 resident handles an increased
number of patients in their weekly continuity clinic compared to previous
years.


r.    Basic medical epidemiology and statistics
We address medical epidemiology and statistical concepts in multiple
venues. PGY1 residents are exposed to epidemiology and statistics in
their first two months in the program through the NIH Perinatal Research
Branch Introductory Course for residents and fellows. One week of the
course is dedicated to teaching epidemiology and statistics. The outline of
this course is attached to the PIF. The department also regularly
schedules journal clubs. These sessions are hosted by faculty members
or are rotated among the department’s divisions. Both faculty and
residents participate. The faculty and residents chose a specialty area
topic, and select/ distribute several articles in advance of the meeting.
Residents on the service lead the discussion. Study design/methods,
patient population, a summary of the findings and implications to our
patient population comprise the basis for discussion. A Division faculty
member functions as the moderator for the discussion. Additionally, an
important outcome measure for competency in basic medical
epidemiology and statistics is the required resident research project.
Further description of this mandatory graduation requirement is described
in Section A10. Another important training source for epidemiology and
statistics occurs via our Grand Rounds program. Grand Rounds
presentations occur on a weekly basis from September through June.
National and international experts are encouraged to supply evidence-
based presentations that highlight the statistical methodologies upon
which management recommendations are based. Statistics and
epidemiology are also reviewed during our annual CREOG review
sessions, as well as during our Board Review course held each year for
                                                                                              46
     the Chief Residents.


     A week of the summer PRB course is devoted to statistics, epidemiology
     and study design.

     s.       Ethics and medical jurisprudence

     We discuss and address ethical considerations in patient care several
     ways. We talk about the principles of biomedical ethics in our CREOG
     exam reviews. The ACOG monograph “Ethics” is distributed to the
     residents in PDF format in preparation for this review. This receives
     reinforcement through specific questions related to these issues given to
     residents during the review process. Patients with challenging
     circumstances and ethical dilemmas are discussed on individual rotations
     as they arise. Faculty members select and discuss ethical dilemmas or
     issues confronting them in the care of their patients, especially those
     managed with residents. In addition, every two months during resident
     protected time, lectures in medical jurisprudence are sponsored by the
     Risk Management Department at Hutzel Women’s and Sinai-Grace
     Hospitals. Residents acquire additional exposure to ethical issues while
     rotating in the Gynecologic Oncology Division and attending a yearly
     formal presentation during Grand Rounds. A city-wide, Ethics retreat that
     couples formal lectures on ethical principles with round table discussions,
     is held on a biennial basis. The residency program, in collaboration with
     medical ethicists from Wayne State University School of Medicine, and
     affiliated hospitals, sponsors this program. One of our MFM faculty
     members and former Program Director, Dr. Theodore Jones brings his
     perspective as the chairperson of the Biomedical Ethics Committee to the
     retreat. He helps residents apply these concepts and principles through
     on-going interactions with them where they talk about and experience the
     role this committee plays to assist clinicians and patients in resolving
     complex situations with their own patients. These interactions place an
     emphasis on ways these situations affect their professional lives. M & M
     conferences in our OB/GYN Grand Rounds series also typically address
     ethical and medical jurisprudence issues.

8.   If changes in the number of residents to be appointed are requested, an explicit description
     of these changes must accompany this material. (Please refer back to pp. vi-vii of the
     instructions to these forms.) This should include:



     a.   the rationale for the change, showing how it will improve the program and benefit the
          other residents.
          One of the major attributes our program offers to prospective residents
          is the opportunity to conduct clinical or basic research. We intend to
          expand this opportunity. Currently there is a one month elective in the
                                                                                                          47
           PGY3 year. At present, one half of the residents select a research
           elective while the other half opts for a clinical or surgical special
           rotation. By adding a twelfth resident, we will make this a two month
           research/elective rotation., If a resident requests basic science
           research, then a minimum of two months is needed to complete this
           type of learning experience. This two month block will be moved to the
           PGY2 year for residents who intend to pursue a fellowship. This will
           allow them time to present their research at national meetings and be
           submitted for publication prior to interviews in the beginning of their
           fourth year. The extra PGY1 resident would rotate on the Family
           Planning rotation. Learning how to communicate with patients in a
           professional manner on personal issues such as birth control options
           and abortion is best done with role modeling and small group
           discussions. This would increase residents’ exposure to and practice in
           the communication/interpersonal relationships and professionalism
           competencies. These competencies can be difficult to teach without
           application and repetition. The additional PGY2 resident would rotate
           to Huron Valley-Sinai Hospital. They would gain additional skills doing
           minor gynecologic cases and working under the guidance of private
           practice physicians. For residents who opt to do two months of
           research as a PGY2, this rotation would be in their PGY3 year. The
           additional PGY4 resident would rotate onto an ambulatory/office
           gynecologic surgery rotation. Our department is beginning to perform
           office procedures such as saline infusion sonohysterograms, office
           hysteroscopy, office tubal ligation by hysteroscopy, and office-based
           endometrial ablation. The resident would also learn how to interpret
           DEXA scans which are performed in our private practice office
           (Woodward). The PGY4 would rotate at an ambulatory surgical Center
           operated by the DMC (Berry Center) for two days of the rotation and
           conduct office procedures at the Woodward office for two days/week.


      b.   an additional narrative description of how the program and curriculum would be
           structured with these changes, including a block diagram of all proposed rotations and
           electives, and



LEVEL OBG -1
Specific                                                                 Family
                      GYN    U/S       FLOAT L&D   Genetics    MFM                 ER       GYN         L&D     L&D    L&D
Assignment                                                              Planning
Institution
                       2         1       1     1        1          1         1         5        1        1       1      2
1,2,3,4,5**




LEVEL OBG -2
Specific                                                                                             Family
                 OB        ONC       FLOAT   REI   OB         OB       GYN       LRC       OB                  MFM    GYN
Assignment                                                                                          Planning
                                                                                                                  48
   Institution
                     1          4            2         1     1       1        3         1        2            1        1           1
   1,2,3,4,5**

LEVEL OBG -3
Specific                            URO
                   MFM    OB             ELECTIVE          ELECTIVE GYN      OB    OB       GYN          OB    FLOAT   GENETICS
Assignment                          -GYN
Institution
                    1      1         1           ANY         ANY         2   2     1         1           1        2            1
1,2,3,4,5**

LEVEL OBG -4
                                                                                     AMB/                              GYN
Specific                                                            GYN                                       SYNERGY
                   OB*    GYN*        GYN*        AMB*     FLOAT*            OB*    OFFICE        OB*                  ONC Gyn*
Assignment                                                          ONC*                                      MEDICAL*
                                                                                   SURERY*                              *
Institution
                     1      3            3         1         1       4        1    pending           1            6        4           1
1,2,3,4,5**




         c.   letters of affiliation from proposed new institutions, if any, participating in the program,
              together with curriculum vitae of the department chairmen of these institutions.
              None needed, Berry Center Ambulatory Surgery Center is part of the
              DMC and is administered through Sinai-Grace Hospital with whom we
              already have an affiliation agreement.




    9.   Discuss procedures developed for:

         a.   the evaluation of the above stated educational objectives, including core competencies
              and the involvement of the residents, Program Director and faculty,


              We use various methods to evaluate the educational objectives including
              the ACGME six core competencies with active participation in these
              methods from residents, the Program Director, our faculty, and other
              team members. Evaluation forms are available on the resident webpage
              and are available on site. These methodologies are summarized below.

              i.   Competency Evaluations (global) - Resident performance is
                   evaluated after each rotation by the faculty as a whole in each
                   Division. Each Division discusses the residents’ progress at their
                   meeting and makes comments from the Division. We feel that our
                   evaluation format based on the six ACGME competencies has
                   resulted in more comprehensive feedback to residents. We started
                   using this form in July 2003. Marginal or unacceptable evaluations
                   require additional written input that is given to the resident as
                                                                          49
      feedback.

ii.    360 Degree Evaluations- The concept of physician and non-
       physician feedback for resident evaluation and professional growth
       has been targeted by the program administration for
       implementation. We have started to use these evaluations in
       Continuity Clinics, MFM rotations, Family Planning rotations and
       Gyn Oncology rotations for the nurses, support staff and patients
       to assess residents’ performance in the areas of
       communication/interpersonal skills and professionalism.
iii. Focused Assessment of Competency-Surgical Skills (FAC-S)
       This is an evaluation form developed by CREOG to assess surgical
       skills. It has recently become part of our resident evaluation
       processes. The first phase of these evaluations is by skills
       documentation. First, all residents must return skills documentation
       assessments to the residency coordinator. These forms must show
       sign off by a faculty member to indicate, the resident is competent
       to perform key skills CREOG has identified as necessary to
       successfully complete a residency in OB/GYN. Second, the
       Gynecology and Gynecologic Oncology Divisions use these forms
       as part of the resident’s rotation evaluation.
iv. Focused Assessment of Competency-Communication (FAC_C)
    This is another evaluation form developed by CREOG to assess
    residents’ communication skills. These skills are evaluated throughout
    the year on specific rotations. Third Year Medical Student
    Evaluations- Over one hundred medical students who rotate through
    OB/GYN from WSU SOM complete standardized forms that reflect
    resident teaching. Forms are returned to the Medical Education Office
    and reviewed by Dr. Carl Christensen. He provides feedback to the
    residents.
 v. Semiannual Evaluations - Each resident receives an evaluation
       by members of the residency administration twice per year. In
       these sessions, topics for discussion include the resident’s past
       monthly summative evaluations, Grand Rounds attendance, case
       log data collection, research projects, “problem issues”, self-
       evaluation, long term/short term goals, and their personal
       assessment of the program. Emphasis has been placed by the
       program on the vital necessity for these evaluations and the
       facilitation of resident schedules to ensure availability.
       Starting in January 2006, the resident’s faculty advisor began
       conducting the mid-term evaluation.
 vi. Portfolios-We have started the process of resident portfolios for the
       purpose of documenting progress and performance in the program
       according to the competencies and educational objectives. Residents
       are encouraged to submit documents attesting to their efforts in their
       learning. Such items submitted to the portfolio become part of their
                                                                              50
        permanent record. They may include, but are not limited to evidence
        of attendance at a special conference, professional
        presentations/writings (e.g., research), talks or presentations given
        while on service, completion of on-line case studies, CREOG quiz
        questions from the ACOG website, letters of commendation, awards
        received, and evidence of committee work. In addition, we track
        attendance at the Tuesday resident education series supported by
        protected time. We also keep records on trainees who participate in
        various local and state resident research day presentations, give
        national/international presentations, published works and receive
        successful fellowship placements. Residents submit items through
        the residency coordinator that are placed in the appropriate section of
        their permanent record.
vii.    Examination Scores- In addition to the tests stated above, pre and
        post test results from rotations that give examinations (e.g., REI,
        GYN-ONC) are included as part of the competency assessment of
        our residents. Results from the CREOG In-service examination,
        USMLE Step examinations, and the multi-program collaborative
        Southeastern Michigan Continuing Medical Education consortium
        oral examination are monitored for all trainees. Lastly, the annual
        report from the American Board of Obstetrics and Gynecology
        revealing the unlinked test results of our graduated trainees is
        discussed and incorporated into our annual program review.
viii.   Monthly Education Meetings with the Residents—The Chair
        continues to meet monthly with the residents during the Tuesday
        resident education series. This approach was expanded in the Fall
        2003 to include regular monthly meetings with the residency
        program administrators to provide a time and place for face-to-face
        open communication about program updates and issues.
 ix.    Faculty Advisor Meetings- This program pairs each resident with
        a faculty member as part of our support for their training. Faculty
        advisors assist the residency program administrators by monitoring
        and counseling residents on their ACGME competencies with
        respect to clinical performance and in other professional issues.
  x.    Resident Education Meetings - These meetings are scheduled
        every month with select faculty representing each Division, the
        executive chief residents, a psychologist, and the residency
        administration. Long-term planning for departmental educational
        goals occurs in these meetings. Meetings also serve as a critical
        forum for the dissemination of information about matters that
        require urgent attention. Resident performance issues are
        discussed with committee recommendations used by the program
        administrators at the time that feedback/evaluation is shared with
        the resident.
 xi.    Annual Program Review— The residents complete a survey that
        assesses the program and solicits qualitative as well as quantitative
                                                                                           51
            feedback.
     xii.   Special Meetings- When issues arise or a resident receives a
            marginal or unsatisfactory rating on his/her monthly summative
            evaluation (i.e., a score of “4” or less or “no” response), a special
            meeting between residency administrators and the resident is
            scheduled. Evaluation forms are screened by the residency
            coordinator or one of the residency program administrators upon
            their return to cross check for satisfactory performance. A
            representative from the rotation where the unsatisfactory or
            marginal performance grade was given also informs the Program
            Director to alert him to the situation. The executive chief residents
            may be part of this meeting as well. Problems are identified, and a
            plan for internal remediation or corrective action is determined.
            Follow-up meetings are conducted to track, assess and document
            progress as needed. These are infrequently occurring events.
 xiii.      Communication between Residency Program Administrators-
            The residency program administrators page, telephone, e-mail and
            stop by each other’s offices to talk about resident performance
            situations as they occur. This constant surveillance of resident
            training has given us the opportunity to intervene earlier and
            prevent additional issues or help correct problems in a timely
            fashion.




b.     the formal, written and anonymous evaluation of faculty by residents and the evaluation
       of the faculty by the Program Director (and the chair, if appropriate),


       A written, summative form has been developed for residents to use to
       assess the quality of the faculty’s teaching abilities with respect to
       residents. This form has become part of the resident’s responsibilities to
       complete in order to receive credit for the rotation. The information
       collected in the resident evaluations of faculty is collated by frequencies
       of each rating on the form over time so that confidentiality is maintained.
       Written comments are expunged of any specific identifiers related to
       individual residents and collated as a summary statement. This is
       evaluated by the administration on a twice, yearly basis unless screening
       reveals particularly concerning comments or evaluation scores. In these
       situations, timely intervention is taken. The Chairman utilizes this
       information during his yearly faculty evaluations for performance. These
       assessments play a role in recommendation for merit salary adjustments
       and are used in faculty promotion and tenure reviews.

c.     the evaluation of residents, including semiannual and final evaluation, and
                                                                                          52

         A form has been developed for these reviews. Residents will receive a
         certificate for each year that they have satisfactorily completed the
         academic requirements for the year that indicates they have met the
         ACGME six competencies. Residents completing the program have a
         form in their folders that attests to the successful fulfillment of the
         residency program requirements. Faculty advisors conduct midyear
         evaluations. The Program Director performs all the end of the year and
         exit interviews. He reviews all midyear evaluations and intervenes in
         special situations as needed.
    d.   the formal, written and anonymous evaluation of the program by residents.


         A formal, written and anonymous annual evaluation of the program by
         the residents has been developed. The numerical findings are
         statistically assessed and the qualitative comments summarized. This
         information is shared with the residents and the residency program
         administrators. This document becomes part of the strategic planning
         process used to improve and maintain program quality.

10. Describe the involvement of and support for the residents in research and other scholarly
    activity. Is resident research a requirement?

    Resident research, not just a case study, is a requirement for graduation.
    Residents join research faculty/fellows in current projects, or have been
    mentored in their own investigations. The Department requires the
    resident to develop a hypothesis, formulate a study design, recruit patients
    or utilize secondary data sources (e.g., chart reviews), analyze the data,
    and discuss results and conclusions. The resident presents his/her
    investigation in March at our Annual Resident’s Day conference in March
    of the graduation year, or earlier if he or she wishes to do so. Faculty and
    residents attending this conference formulate questions that the resident
    addresses following his/her presentation. The presentations are judged,
    feedback provided and special awards given at graduation for the best
    investigations.

    Research, in addition to the required research project, continues to be an
    essential component of the curriculum. Over the past year, 17 residents
    have been selected for oral presentations or posters at national meetings.
    Thirteen resident’s projects were selected for presentation on May 23,
    2007 for the Michigan section of ACOG. The department has a large
    commitment to resident research in several ways. We are one of the only
    residencies in the country that offer PGY2 or PGY3 residents a two month
    research block for those individuals who wish to pursue basic science
    research during their training. The first resident who took advantage of this
    opportunity has had three presentations at national meetings from this
                                                                            53
    basic science research. There are four residents who wish to pursue this
    option for the 2007-2008 academic year. Another way in which the
    department supports resident research is by reimbursing the expenses for
    any resident whose project is accepted for presentation at a national
    meeting.

    Several faculty members support research efforts. For example, Dr.
    Michael Diamond, the Obstetrics/Gynecology Research Director, Michael
    Kruger, the Department Statistician, and Marappa Subramanian, Ph.D.
    coordinate or participate in a series of lectures each year on the topics
    including study design, data analysis, and statistics. Guest speakers at
    Grand Rounds and at in the resident education lecture series provide
    additional reinforcement in research principles. Statistical analytical
    support is available upon request from Mott, the medical school,
    numerous faculty members, or the NIH Perinatology Research Branch
    (PRB) as needed. Many physicians oversee resident research projects
    (e.g., Dr. Diamond, Dr. Christensen, Dr. McNeeley, and Dr. Romero).
    Residents continually hear about cutting edge research nationally and
    internationally conducted by the principal investigators responsible for
    these projects through attending Grand Rounds. They also have
    opportunities to present regularly at OB/GYN Grand Rounds M & M
    conferences. These one hour conferences, prepared with faculty
    guidance, provide rich opportunities to apply, debate and share research
    concepts of challenging patient management cases experienced by
    trainees. Morning rounds and Board turnovers represent other places
    where faculty lead discussions that encompass research ideas and
    strategies in connection with diagnoses, patient management, or
    intervention techniques.




11. Describe resident on-call facilities and clinical support services.


    On-call facilities. Hutzel Women’s and Sinai-Grace Hospitals on-call
    facilities include updated private and semi-private rooms, equipped with
    bathrooms in the room or near-by. Each call-room contains a telephone.
    Desks and televisions are present in most rooms. The Hutzel Women’s
    Hospital call rooms come equipped with laptop hook-up capacity. Hutzel
    Women’s Hospital maintains 10, single bed call rooms utilized by faculty,
    residents, and medical students. Sinai-Grace has three call rooms.
    Additionally, bathroom and shower facilities are available next to or within
                                                                         54
both male and female physician locker rooms at all institutions. Custodial
services personnel have been scheduled to clean the rooms after their
use each day. Residents do not take call at Huron Valley Sinai Hospital.

Clinical support services. All hospitals have a multitude of clinical support
services (e.g., physical therapy, social service, clergy, dietary, pharmacy,
lab services, x-ray, surgical staff, dietary, library and computer support).
For example, at Sinai-Grace Hospital, physician assistants function with
the residents in the Labor and Delivery triage area. Clinical research
nurses assist the residents in consenting and enrolling participants in
clinical studies. These nurses also help residents gather necessary data
for on-going studies on Labor and Delivery. At Hutzel Women’s Hospital,
residents consult and team with nurse midwives on L & D. Nurse
clinicians and physician assistants are part of clinic teams and see a
majority of the normal obstetrical patients. Consultations with other
specialty services are common (e.g., emergency room, internal medicine,
cardiology, pediatrics, urology, psychiatry, rheumatology, physical
medicine and rehabilitation).

12.       For each institution participating in the program:

a.    describe the patient population that receives obstetric and gynecologic care from the
      residents with supervision by the faculty, including its relative volume, demographics
      and any specific characteristics; and

      Hutzel Women’s Hospital/University Health Center (UHC)

      The insurance status of the majority of patients seen at Hutzel and
      UHC can be classified as underinsured (Medicaid and Medicaid
      HMO’s) or uninsured. Approximately 25 percent of patients admitted to
      the hospital are privately insured patients. Thus, most of our patients
      represent an urban, low socio-economic population that often
      encounters significant obstacles obtaining and maintaining access to
      medical care. The UHC is the main clinic for Hutzel Hospital Ob/Gyn
      patients. Residents provide care through continuity clinics and
      specialty clinics (High Risk, Colposcopy, Family Planning, Substance
      Abuse) under the supervision of the full time OB/GYN faculty.

      The volume at UHC has showed an increasing trend over the last few
      years. There will be approximately 35,000 out patient visits this year at
      UHC. This increase is due to a number of smaller hospitals closing in
      the metropolitan area, as well as an increased number of uninsured
      women in the area. We expect this number to increase further. Detroit
      Riverview Hospital which has similar demographics to Hutzel is closing
      in June, 2007. It is expected that a majority of the 1,000 deliveries
      performed at that institution will move to Hutzel. The relative volume of
      obstetrical and gynecological care accounts for approximately 70
                                                                       55
percent of the clinics’ volume and 50 percent of a resident’s continuity
clinics volume, respectively.

Hutzel Hospital patient population has a high percentage of patients
with multiple and/or severe medical problems. This is due to many
reasons. Most large cities have a system of primary care clinics,
however, this does not occur in Detroit. Without access to primary
clinics, many women do not come to the clinics or the Emergency
Room until they are very sick. The NIH Perinatal Research Branch is
based in Hutzel Hospital in part due to the high numbers of women
with complex obstetrical and gynecological medical problems seeking
care at Hutzel Women’s Hospital.

Sinai-Grace Hospital
The majority of clinic visits consist of private patients. Intrapartum and
postpartum care is provided by the resident under the supervision of
the patient’s private attending. The remaining patients are primarily
taken care of by faculty with the assistance of residents. The payer
mix for this patient population is more diverse than found at the UHC.

Patient volume at the clinic has remained consistent over the last
several years. The relative number of patients seen by residents there
is about 2500 visits per year. Five residents have their continuity clinics
based at Sinai-Grace.

Huron Valley-Sinai Hospital
All patients are derived from the practices of private attending
physicians with residents assisting them with their gynecologic surgical
and post operative care. The majority of the patients seen at Huron
Valley-Sinai Hospital represent middle to upper socioeconomic
populations.

Karmanos Cancer Center

All patients are referred to the cancer center from outside physicians or
as self referrals.These patients are seens in the Karmanos clinic under
the supervision of the gynecologic oncologist in the office that day. The
clinic has approximately 4000 visit a year


Synergy Medical Education Alliance
All patients are derived from the practices of private attending
physicians with residents assisting them with their gynecologic surgery
and postoperative care. The majority of patients treated represent the
middle socioeconomic status population.
                                                                                       56
     Detroit Receiving Hospital
     Patient demographics compare similarly to Hutzel Women’s Hospital
     and UHC. Our residents rotate for one month in the Emergency
     Department learning primary care. Gynecologic consults are seen in
     the hospital, but there is no gynecology service.


     Harper University Hospital
     OB/Gyn consults are seen in the hospital and the patient
     demographics are similar to Hutzel Women’s Hospital.

b.   describe the involvement of residents in the care of the patients of program faculty,
     including the relative volume of this population, demographics and any specific
     characteristics.

     Hutzel Women’s Hospital
     Residents see private patients while at the Southfield Clinic on the
     Reproductive Endocrinology/Infertility rotation. The patients seen in
     this setting comprise over 90 percent of the infertility patients in our
     training program. Oncology patients are seen in the Wertz Cancer
     Clinic in the Karmanos Cancer Center on the central campus. The
     patients seen at the Wertz Cancer Center comprise over 95 percent of
     the oncology patients seen by residents in our health system. Since
     only one and two residents, respectively, rotate on these services from
     the program at a time, this constitutes a sizeable exposure. The patient
     population is diverse and ranges from Medicare/Medicaid to middle to
     upper socioeconomic status with private insurance coverage. Some
     patients fly in from other regions of the country for the high quality of
     specialty care provided. While the patients are considered private,
     residents are actively involved in office decisions and subsequent
     surgeries when performed. This volume of patients accounts for less
     than 15 percent of the overall volume of patients seen. Urogynecology
     patients are seen at the faculty private practice located at 3750
     Woodward under the supervision of Dr. McNeeley and Dr. Hendrix..
     Approximately 95 percent of the urogynecology patients seen at Hutzel
     Women’s Hospital are evaluated in this office. The patient population is
     diverse. Twenty-five percent of the volume consists of Medicaid staff
     patients and seventy-five percent represent private insured patients

     Sinai-Grace Hospital
     Approximately 80 percent of the patient population is private. The
     residents, however, are very active in the intrapartum, postpartum
     and/or surgical management of these patients. The remainder of
     patients come from the Sinai-Grace Clinic that provides the setting
     where the residents provide obstetrics and gynecology ambulatory
     care with supervision by the faculty. This outpatient instruction is
     provided by both full-time faculty and private attending physicians
                                                                                57
        employed to staff these clinics and provide educational oversight. The
        obstetric inpatients receive their antepartum, intrapartum and
        postpartum care from the residents, with instruction and oversight of
        the attending physician. For the clinic and staff patients, this is
        provided by the 24-hour call attending staff that is comprised of both
        full-time faculty and private attending physicians. For private patients,
        the private attending physicians provide supervision.

        Huron Valley-Sinai Hospital and Synergy Medical
        All of the gynecologic services are through interaction with the private
        attendings at the time gynecologic surgery is provided. Residents are
        not involved with private attending obstetrical services. The population
        reflects middle to upper middle socioeconomic levels under several
        insurance carriers.

        Karmanos Cancer Center

        The faculties private practice is the cancer centers clinic as
        described above

13. For each institution participating in the program, describe the process by which residents
    become involved in the management of patients requiring surgery, including the
    preoperative encounter, the performance of the surgical procedure, including their level of
    responsibility, and the postoperative care of the patient.


    Institution: Hutzel Women’s Hospital

    There are several rotations at Hutzel Women’s that involve care for
    surgical patients: Operative (staff) Gynecology, Ambulatory Gynecology,
    Reproductive Endocrinology, Gynecologic Oncology, and the private
    Gynecology service.

    Operative Gynecology:

    The Division of Gynecology is responsible for the supervision of residents in
    out-patient and in-patient care, as well as supervising and teaching surgical
    procedures. The Gynecology service at Hutzel Women’s Hospital consists
    of a PGY 1,2,3, 4 resident. The first year gynecology resident, in
    consultation with the senior resident, provides daytime coverage for the
    gynecology floor, and the emergency rooms at both hospitals. The
    attending physician of the week meets with the residents daily at 7:00 a.m.
    for rounds. The status and management plans of all inpatients and
    consultations are reviewed. All staff patients are seen with the attending
    physician. All inpatients and consultations over the last 24 hours are
    reviewed. Patients are seen with the attending physician assigned for that
    week. The Department of Obstetrics and Gynecology has requested that no
                                                                          58
elective surgeries begin before 8:00 a.m. daily and 1:00 p.m. on Tuesdays,
to allow for adequate time for teaching and attendance at the educational
sessions scheduled during that time period. A preoperative conference is
held on Friday mornings, with the weekly attending. Cases for the upcoming
week are discussed, as well as a review of complications occurring during
the current week. In conjunction with the Department of Pathology, a
Colposcopy/Pathology review conference has been in place for five years.
This conference occurs every Wednesday at 8:00 a.m. CME credit is
provided by Wayne State University for practicing physicians.

Elective surgery is performed four and one-half days weekly, at both Sinai-
Grace Hospital and Hutzel Women’s Hospital. Surgical responsibility is
gradually increased from the first year level (dilatation and curettage, basic
laparoscopic surgery) through the senior year (vaginal surgery and pelvic
reconstructive surgery).

In general, junior residents receive oversight for patient care issues from
senior residents and physicians responsible for the patient. Final
responsibility for patients rests with the senior resident with attending
physician supervision. The resident assigned to the case provides
postoperative care. Postoperative complications and management
problems are discussed with the attending gynecologist for the case.

In the PGY1 year, emphasis is placed upon learning laparoscopic
procedures and ambulatory vaginal procedures. There are occasional
opportunities to second assist on abdominal and more complex vaginal
surgeries.

PGY2 residents have opportunities to learn the proper evaluation and
management of gynecologic problems of staff patients. Staff patients are
admitted for surgery from the emergency room, UHC continuity clinic, and
the UHC ambulatory gynecology service. Responsibility in the operating
room is broadened to include a wider range of abdominal surgery and
operative laparoscopy. Junior residents receive oversight for patient care
issues from senior residents, and physicians responsible for the patient.

PGY3 residents are typically responsible for the evaluation and
management of more clinically challenging patients once identified in the
ambulatory setting. Resident’s l gain skills in planning surgery and
ordering associated ancillary services. They provide leadership to the
team in the absence of the PGY4 resident.

PGY4 residents assume overall responsibility for the patients scheduled
for surgery through the clinic, and assist the faculty in decision making
concerning the distribution and assignment of surgery coverage in the OR.
It is necessary for them to develop a keen awareness of the capabilities of
                                                                         59
the resident surgeons on their teams, as well as the individual needs of
the attending surgeons based upon the complexity of the surgery, and
variations in techniques. They operate on the most challenging cases.
Patients undergoing elective surgery are typically presented the preceding
Friday during the preoperative conference.

Resident education in advanced endoscopic surgery is provided by the
Department of Obstetrics and Gynecology. This includes both ambulatory
surgery experience, as well as an ongoing animate and inanimate
laboratory experience. The department has purchased a virtual reality
laparoscopic simulator to help advance laparoscopic skills. This ongoing
laboratory exercise provides a sound and safe foundation for developing
surgical skills required in the OR.

Huron Valley-Sinai Hospital is covered by a PGY4 resident. This is an
ideal time for the resident to gain surgical experience prior to completion
of their residency. The resident has no obstetrical responsibilities during
the Sinai-Grace Hospital rotation.

Ambulatory Gynecology
The PGY4 resident is assigned a one-month ambulatory gynecology
experience. During this month, the resident works in the private office
setting with several attending physicians. This allows better
comprehension of conservative, non-surgical interventions, as well as the
appropriate pre-operative work-up for patients. Patients are seen pre-
operatively on the day of admission for surgery and are followed post
operatively by the same resident.

Reproductive Endocrinology and Infertility (REI)
Patients seen at the Southfield Clinic who are to undergo surgery are
handled by the individual REI attending and also by the resident on the
REI service. The majority of patients who undergo major surgery are
evaluated and managed by a senior resident. The administration and the
Division have made an effort to increase resident participation in all REI
surgeries. When no REI fellow is present, the resident functions as a first
assistant in the case. When a REI fellow is present, the resident performs
the surgery with the fellow under faculty supervision. Residents follow
admitted patients postoperatively. In addition, residents gain surgical
experience in infertility related surgery while working with gynecology
faculty on other campuses as well as cases identified through their
continuity clinics. Residents evaluate their patients and perform
appropriate diagnostic tests and surgery under direct faculty supervision.
Residents from other institutions perform surgery as second assistants
unless there is no program resident available to perform the procedure.
                                                                             60
Private Gyn Patients
The resident sees the majority of these patients on a same day admission
basis. The resident performs a history and physical and then follows the
patient postoperatively, regardless of level of training.

Institution: Sinai-Grace Hospital
The surgical service is comprised almost exclusively of private patients
who have been boarded for surgery after evaluation by their attending
physician. The senior resident assigns cases for coverage similar to the
process described for Hutzel Women’s Hospital. In addition, postoperative
care is provided under the guidance of the attending physician for the
case. Responsibilities of the care for staff patients is given to the senior
resident and the coordination of team

Institution: Huron Valley-Sinai Hospital
One or two chief residents cover scheduled major and laparoscopic
surgery cases in this private surgical patient population. The site director
and Program Director make copies of the surgical schedule available to
the residents for review and assignment. The residents for covered cases
provide preoperative, operative, and postoperative care

Karmanos Cancer Center

The Gyn Onc service is a major source of experience in pelvic surgery
during the senior year. In the past, the combination of surgery, floor
coverage, and emergency room coverage combined with Oncology call
prevented the residents from gaining experience in the preoperative work-
up of patients with pelvic masses and management of difficult colposcopy
cases. In order to rectify this, the on call responsibilities of the General
Gyn and Gyn Onc were combined to allow the residents rotating on Gyn
Onc to evaluate patients with the Gyn Onc attendings. The residents now
see patients preoperatively rather than on the day of admission. This has
produced a better experience for the operating resident. Residents from
other institutions operate as first assistants only if there are additional
cases not covered by WSU residents. During this rotation, the principles
of hypogastric artery ligation and repair of bowel and bladder injury are
reviewed. The resident performs these procedures under the supervision
of the Oncology faculty during benign gynecology cases and gynecologic
oncology cases.



Institution: Synergy Medical Education Alliance
The surgery service is comprised of private patients who have been
boarded for surgery after evaluation by their private attending physician.
Post operative care is provided under the guidance of the attending
                                                                                                61
    physician. . Indications for surgery and preoperative workup will be
    reviewed between the attending the visiting Hutzel resident.



14. The ACGME is monitoring the implementation of general competencies and assessment by
     using a common data collection tool. Log onto the Web Accreditation Data System and
     proceed to the Site Visit Information section and select Update/Verify Competency and
     Assessment Form to enter your information. Once the information has been entered and
     saved, select Print ADS Competency and Assessment Form to generate a printed copy of
     the form an attach it to the end of the PIF.



ATTACHED




15. Describe the continuity clinics in detail, together with the typical panel of patients that all
    residents maintain. (See Program Requirements, Section V. A. 1.d)

    The majority of patients seen at the University Health Center are seen in
    the continuity clinics. There are nine half-days of continuity clinic each
    week. We are on track to have 35,000 patient encounters at the UHC
    clinics this year. These visits include three half days a week of
    subspecialty MFM Clinics, three half days a week of Colposcopy Clinics,
    four half days a week of family planning clinics. The remainder of all
    patient visits is through resident continuity clinics.

    In the past, 90 percent of a resident’s patient load was OB visits. Since
    2003, five nurse practitioners have been hired to see the majority of the
    normal OB patients. The nurse practitioners see over 50 percent of the
    normal OB patients at the clinic. Due to the presence of the nurse
    practitioners, we have instituted a policy that a resident’s continuity clinic
    schedule must have a minimum of 50 percent gynecology patients for
    each session. PGY2 through PGY4 residents are scheduled to see an
    average of 8-14 patients for each half-day session. The number of
    scheduled visits increases by year.

    A faculty member of the OB/GYN staffs each continuity clinic. On
    average, there are two to four residents present at each session. The
    residents are assigned a specific half-day throughout the year. Residents
    are expected to attend their continuity clinic unless they are on vacation,
    on a week of nights for OB, night float or LRC. We have set residents’
    clinic days to allow greater continuity in patient care, ease scheduling, and
    to maximize resident attendance. Patients are given return appointments
    with the residents they are assigned to see. If a resident’s schedule does
    not permit them to see the patient as scheduled, and the patient cannot
                                                                                            62
    reschedule, the patient will see one of the other residents.

    Referrals from the Emergency Room and other clinics are sent to resident
    continuity clinics with the intention that the resident sees these patients as
    long as they need care. Protocols for preventative care and
    immunizations are posted in the continuity clinics as well as ACOG
    protocols that guide patient care. Patients with severe medical problems
    (e.g., advanced cardiac disease) are referred to an internist for
    consultation and on-going care.

    Sinai-Grace continuity clinics are located in a professional building
    adjacent to the hospital. Academic faculty and a small number of private
    attendings provide supervision. Scheduling and configuration are
    modeled upon the UHC site. The faculty and attendings in the clinic
    partner with residents to provide patient care, including the performance of
    surgery when necessary.

16. Describe areas that have been identified for improvement. What strategies have been
    developed to deal with them?

            a.   Increase the number of vaginal surgical cases performed by our residents

                 Increasing the number of vaginal hysterectomies and surgical
                 cases has been a priority for our program. Our graduating
                 PGY4 residents have an average of 20 vaginal hysterectomies.
                 This appears to be at the 25th percentile for programs across the
                 country. We would like this number to be at the 50th percentile.
                 To accomplish this goal, an outside extramural rotation was
                 added for PGY4 residents at Synergy Medical in Saginaw.
                 Expectations are for our residents to perform 7 to 10 vaginal
                 hysterectomies during that month. This rotation will also
                 increase the number of urogynecologic procedures our
                 residents perform.

            b.   Improve office ambulatory surgical experience

                 Our department has just purchased the equipment to perform
                 office hysteroscopy. We will begin performing these procedures
                 on selected patients. We will also begin to perform
                 hysteroscopic tubal ligations by essure and office endometrial
                 ablations. Dr. Kmak, the Program Director has been selected to
                 the August 2007 APGO/Ethicon Surgical Scholars Program.
                 The purpose of this program is to improve residents’
                 experiences in hysteroscopy. Through this program, a formal
                 curriculum will be put into place with the most current and best
                 methods to teach residents hysteroscopy.
                                                                            63
     The department is sponsoring a hands-on hysteroscopy
     workshop supported by ACMI on July 10, 2007. The company
     is bringing four workshop stations to our institution along with
     training personnel to provide additional training for our residents
     in hysteroscopy.

c.   Implement simulation training

     Our program recognizes the importance of simulation training.
     Simulation training has just been initiated in laparoscopy with
     required training during the year on a virtual reality trainer. The
     process of implementing obstetrical simulation training began in
     spring 2007. Obstetrical simulators were evaluated at the
     annual APGO meeting as well as techniques for teaching
     obstetrical simulation. The current proposal is to obtain a
     simulation trainer to simulate deliveries with
                -shoulder dystocia
                -breech delivery
                -forceps delivery
                -postpartum hemorrhage
                -management of fetal distress

     The obstetrical process improvement team at Hutzel and Risk
     Management has mandated the documentation of annual
     physician training in the management of shoulder dystocia and
     abnormal fetal heart rate tracings. Our intent is that the
     simulation scenarios developed for the residents will be used for
     the annual attending physician documentation.


d.   Improve the documentation of cases entered into the resident’s ACGME
     caselist
     This is an area that has improved dramatically, but needs
     further refinement. Residents’ case list numbers became an
     outcomes measure our program began monitoring differently
     than previous methods used prior to 2007. Hutzel is one of the
     busiest OB/GYN hospitals in the country, but our residents
     ACGME numbers do not reflect this accurately. For the past
     year warning letters were sent to residents on a monthly basis if
     they had not entered cases over a two week period. Despite
     these warnings, cases were not getting entered in a timely and
     accurate fashion.

     In March 2007, a new method of resident monitoring was
     started. At this time, the average number of cases performed by
     residents at the end of their training was sent to all residents
     along with a spread sheet of all residents’ totals, class year
                                                                            64
     averages and class year standard deviations. These numbers
     are reviewed by the Program Director every two weeks.
     Beginning July 1, 2007, any resident whose totals for a
     procedure fall below one standard deviation from the average
     number required automatically has their totals reviewed. If the
     total number(s) recorded are low due to lack of case entry then
     that resident is not allowed to take vacation (vacation time is not
     taken away, but rather withheld) until he or she enters the
     cases. In addition, no travel reimbursement is allowed until
     cases are entered. The resident also will meet with the
     Program Director and continued failure to enter cases will lead
     to academic disciplinary action. Rationale for compliance given
     to the residents emphasizes that entering these cases displays
     compliance with key components of the ACGME competencies
     involving professionalism, written communication, and systems-
     based practice.

e.   Expose our residents to cosmetic gynecology
     The field of cosmetic surgery has been monitored closely by our
     department. It no longer appears that cosmetic gynecology will
     be a short term fad. The field is growing and a significant
     number of gynecologists are incorporating laser and types of
     liposuction into their practice. The program is exploring options
     of developing these areas and incorporating them into
     ambulatory teaching. The present plan is to have a few of the
     gynecology faculty learning these procedures and begin
     teaching residents the basic techniques and understanding of
     these procedures.

     There is an annual Wayne Day conference held in the Fall
     covering a different OB/GYN related topic. The topic for 2007 is
     Cosmetic Gynecology.

f.   Correct areas of concern and non-compliance from the 2004 site visit
     The areas of non-compliance and concern have all been
     addressed and information dealing with these concerns can be
     found attached to the front of this PIF. We believe that a number
     of these problems were related to lack of data entry into the
     ACGME case log system. We understand that programs “live
     and die by the numbers entered”. Thus, we are adopting
     methods to improve the documentation of resident’s
     experiences for the better livelihood of the program. We have
     also initiated changes in the program to address previous areas
     of concern expressed by the RRC.
                                                                                             65
SECTION B. PROGRAM DIRECTOR
1.   What is the time commitment of the Program Director, including assistant Program Director,
     if any, (in hours per week) to the residency program (See Program Requirements, III.A.2.a)?
     Detail both administrative and teaching time.

     The Program Director commits a minimum of 50 percent of his time and
     the Associate Program Director 20-25 percent of his time to the
     residency program. For the Program Director, this approximates 20 to
     25 hours per week on site. This is administrative time and is not
     included as teaching or clinical time. The Associate Program Director
     spends approximately 20 hours per week on site as well, with 12 hours
     in clinical supervision, 2 hours in administration, 2 hours in research,
     and 5 hours in teaching. In addition, the Department Education Division
     includes a full time Residency Coordinator and an Education Director.
     The new Education Director, Alaina Bruce-Jackson is in the process of
     learning how we have implemented the competencies into our program
     pertaining to rotation objectives, evaluations and outcomes

     The Program Director and these two individuals function as a team for
     the administration and oversight of the program. In addition, we have a
     new Associate Chair for Education, Ray Bahado-Singh, M.D. He
     provides leadership and oversight for residency education as well. In
     just a short time, he has joined our Resident Education Committee,
     assisted in supervision and counseling of residents with special needs,
     and provided advice on our budget. The scope of our residency
     program medical education administrative activities include, but are not
     limited to the following: review, approval and coordination of the
     rotations and schedules as organized by the executive chief residents;
     planning for and running the monthly Resident Education committee
     meetings; coordinating scheduled activities that include weekly Grand
     Rounds, case presentations and teaching rounds; organizing review
     sessions prior to the CREOG in-training examination (November -
     January) and didactic lectures for the residents; journal club
     coordination; oversight of direct resident teaching by the faculty in
     ambulatory settings, operating rooms, and Labor & Delivery; and
     accreditation review preparation. An important role involves
     administering all aspects of the resident recruitment program. Examples
     include reviewing applications, interviewing and leading orientation
     sessions for residency candidates. The medical education
     administrators participate in and oversee the dissemination of resident
     evaluations, track/assess/ provide feedback for the collection of case
     experiences, or meet with residents to discuss their evaluations, with
     subsequent formulation, implementation, monitoring, and evaluation of
     performance improvement plans as necessary. The Program Director
     provides leadership and front line supervision in all of these areas with
     special attention to coordination and guiding the team with respect to
                                                                                 66
     resident performance and program issues. He serves as a role model to
     instill a fair, open, positive, and challenging, learning environment where
     residents can express concerns and make suggestions for program
     improvement that will be taken seriously and acted upon where
     appropriate.

2.   How does the Program Director ensure that the residents are provided with a written
     statement of educational goals and objectives for each major rotation/assignment?

     Educational objectives have been revised over the past year so that every
     rotation has goals and objectives for each academic level of training. Each
     written objective is linked to a specific competency or competencies, , in
     addition to listing corresponding teaching methodology(ies) and detailing
     different evaluation tools used to measure successful completion of the
     specific behavioral objectives.
3.   Does the Program Director provide written guidelines to all faculty and residents concerning
     supervision of residents by faculty? Please have available for the site visitor.

     Yes. This document is available on site.

4.   What mechanisms does the Program Director have in place for resident grievances and the
     monitoring of resident stress?

     The Program Director and his medical education administrative team
     provide leadership and direction for resident grievances and stress
     reduction. Depending on the nature of the grievance, residents are
     informed of alternative reporting and support avenues available, such as
     WSU or DMC Human Resources Department, consultation with the
     resident’s faculty advisor, or referral to the Employee Assistance
     Program. All OB/GYN Medical Education Administrators maintain a
     confidential, open door policy for discussion of issues.
     ACADEMIC DISCIPLINE: The process for correcting and improving
     unsatisfactory performance is as follows: the Program Director initiates
     this process and may use the Resident Education Committee as a
     consultative resource. In a meeting including the resident, the Program
     Director and at least one other OB/GYN education administrator, the
     Program Director focuses upon and addresses specific performance
     concerns, requests input from the resident, details performance
     expectations, and establishes an action plan. As a result of this
     meeting, corrective actions can include:
             -no further action necessary
             - monitoring only of the established remedial plan
             - placement on departmental internal remediation,
             -recommendation to the University GME Office for further
             corrective action.
                                                                             67

Unless resident difficulties indicate unsafe or unprofessional
performance, these plans are handled internally as a remediation plan.
Confidential records are kept separate from the resident’s permanent
file. The resident’s progress is periodically monitored and reviewed by
the Program Director according to the remedial plan. At the conclusion
of the monitoring period, the resident’s performance is once again
reassessed. Initiation of corrective action, a revised monitoring plan or
documentation of satisfactory completion of the remediation plan is
decided.
In situations where unsafe or unprofessional behavior is identified,
institutional corrective actions begin according to the GME written policy
provided to each resident in their residency policy and procedure
manual.
RESIDENT STRESS: Stress is monitored and assistance for reduction is
handled in several ways. The OB/GYN Medical Education Administrators,
executive chief residents and faculty advisors are identified as resources
for residents experiencing unresolved distress. Residents also gravitate to
self-selected faculty members and nursing personnel. The Executive
Chief Residents bring stressful clinical issues or residents who need
support to the attention of the Program Director. Traditionally, each class
uses their colleagues as a support system to reduce stress. Many
residents participate in impromptu social outings for stress relief. Pot-luck
dinner parties with the nursing staff provide comfort food and relaxation.
Past resident retreats have focused on stress reduction techniques. The
OB/GYN Chair, Dr. Malone, hosts a series of dinners at local restaurants
to encourage social communication between residents and faculty. He
meets monthly with the residents for “Chairman’s Rounds”. When a
resident requires or requests counseling, he/she is referred to the
WSU/DMC Employee Assistance Program (EAP) by the Program Director.
Alternatively, the resident is encouraged to seek professional assistance
under his/her health insurance. The Michigan Health Professional
Recovery Program, under contract with the State of Michigan, is available
for referral for those residents identified with substance abuse and
behavioral health disorders. This allows the resident an opportunity to
seek treatment without regulatory involvement of the State Board of
Medicine.
                                                                                                       68
 5. Program Director CV form. Please do not attach actual curriculum vitae.

Name of Program: Wayne State University/Detroit Medical Center
Address: 39803990 John R, 7 Brush North
City/State/ZIP Detroit, MI 48201
What is the term of appointment of the Program
                                                      One year
Director?:
Name: David C. Kmak, M.D.
Office Address: 39803990 John R, 7 Brush North
City/State/ZIP Detroit, MI 48201
Phone: (313) 993-41364030                             FAX: (313) 993-4116
E-mail: dkmak@med.wayne.edudkmak@med.wayne.edu
Medical School (institution and dates): Wayne State University School of Medicine 1982-, 1986
Post-graduate education (Institutions and dates):
Internship and residency – Wayne State University Affiliated Hospitals Program, Detroit Mi, 1986 - 1990

Major professional work experience (Location, nature of position or title, dates to present):

Assistant Professor of Obstetrics and Gynecology, Wayne State University (1990-2005)
Associate Program Director, Wayne State University (2003 – 2005)
Medical Director of University Health Center OB/GYN clinic, (1999 – 2005)


Describe background/experience and years in residency education:
Regular lecturer for medical students, 15 years
Preceptor for rotating MS III 3/yr, 15 years
Director of University Health Center Clinics for OB/GYN

Duties in current position and how they relate to this program: Conduct oversight of the educational
programs for the Department and serve as the lead administrator for all the activities related to
residency education

Licensure:
Michigan Board of Medicine – 1992
Board Certification:
        (x)
ABOG?              ( ) NO Date: 1992                   # 905664               Recertification Year: 2005
        YES
Subspecialty certification:
                            Type:                      Date:                  #
no
Other (Specify)
                                                                                                                                                                                 69

SECTION C. FACULTY
List below those in this institution who participate directly and regularly in the teaching program, including non-clinical faculty, and generalist faculty and other specialists, up
to 20 names. Please do not attach copies of faculty vitae.

1. Institution Name      Hutzel Women’s Hospital

                                                                                           Original and
                                                     Original and                                                                    Specific        percent of
                                                                         Area of Sub-      Most Recent            Primarily at                                        Mos./Yr. on
                                                     Most Recent                                                                    Teaching         Practice in
Faculty Name                                                              Specialty         Year Sub-             Institution                                          Teaching
                                                         Year                                                                       Responsi-         Primary
                                                                         certification      Specialty              1,2,3,4,5*                                           Service
                                                     Certification                                                                   bilities**       Hospital
                                                                                           Certification
Ray Bahado-Singh, M.D.                            1988        1996     MFM               1991     1996        1                  MFM               100             12
Susan Berman, M.D.                                1993        2001     MFM               1996       2001      1                  MFM               50              12
Lori Billis, M.D.                                 2002                 Gynecology                             1                  Gynecology        100             12
Carl Christensen, M.D., Ph.D.                     1989        2001     Gyn Oncology      1989       2001      1                  Gyn Oncology      100             12
Gunter Deppe, M.D.                                1976                 Gyn Oncology      1979                 1                  Gyn Oncology      100             12
Michael Diamond, M.D.                             1988        2006     Endocrinology     1989       2006      1                  Endocrinology     100             12
Kenneth Ginsburg, M.D.                            1988        1997     Endocrinology     1990       1997      1                  Endocrinology     100             12
Susan Hendrix, D.O.                               1990        2006     Gynecology                             1                  Gynecology        100             12
Theodore B. Jones, M.D.                           1988        1998     MFM               1998                 1                  MFM               100             12
David Kmak, M.D.                                  1992        2006     Gynecology                             1                  Gynecology        100             12
John M. Malone, Jr., M.D.                         1983        1998     Gyn Oncology      1989       1998      1                  Gyn Oncology      40              12
Giancarlo Mari, M.D.                              1998                 MFM               2000                 1                  MFM               100             12
S. Gene McNeeley, M.D.                            1983        2006     Gynecology                             1                  Gynecology        100             12
Robert Morris, M.D.                               1997                 Gyn Oncology      1999                 1                  Gyn Oncology      100             12
Adnan Munkarah, M.D.                              1996                 Gyn Oncology      1998                 1                  Gyn Oncology      100             12
Renee Page, M.D.                                  2006                 Gynecology                             1                  Gynecology        100             12
Veronica Schimp, M.D.                             2005                 Gyn Oncology      2006                 1                  Gyn Oncology      100             12
Robert J Sokol, M.D.                              1972        1986     MFM               1975                 1                  MFM               100             12
Yoram Sorokin, M.D.                               1980        1997     MFM               1982       1997      1                  MFM               100             12
Diane Vista-Deck, M.D.                            2003                 Gynecology                             1                  Gynecology        100             12

*Institutions as listed in Part 1, Section 2.
**E.g., general gynecology, REI, oncology.
                                                                                                                                                                  70


2. Institution Name      Sinai/Grace Hospital

                                                                                     Original and
                                                  Original and                                                             Specific      percent of
                                                                   Area of Sub-      Most Recent         Primarily at                                   Mos./Yr. on
                                                  Most Recent                                                             Teaching       Practice in
Faculty Name                                                        Specialty         Year Sub-          Institution                                     Teaching
                                                      Year                                                                Responsi-       Primary
                                                                   certification      Specialty           1,2,3,4,5*                                      Service
                                                  Certification                                                            bilities**     Hospital
                                                                                     Certification
Delores F. Baker, M.D.                          1983              Ob/Gyn                             2                  Ob/Gyn          100            12
Bernard Gonik, M.D.                             1987      2006    MFM              1987     2006     2                  MFM             100            12
Karoline Puder, M.D.                            1996      2006    MFM              1998     2006     2                  MFM             100            12
George Shade, M.D.                              1980              Ob/Gyn                             2                  Ob/Gyn          100            12
Leonard Sudakin, M.D.                           1969              Ob/Gyn                             2                  Ob/Gyn          100            12

*Institutions as listed in Part 1, Section 2.
**E.g., general gynecology, REI, oncology.
                                                                                                                                                                  71


3. Institution Name      Huron Valley/Sinai-Grace Hospital

                                                                                     Original and
                                                  Original and                                                             Specific      percent of
                                                                     Area of Sub-    Most Recent         Primarily at                                   Mos./Yr. on
                                                  Most Recent                                                             Teaching       Practice in
Faculty Name                                                          Specialty       Year Sub-          Institution                                     Teaching
                                                      Year                                                                Responsi-       Primary
                                                                     certification    Specialty           1,2,3,4,5*                                      Service
                                                  Certification                                                            bilities**     Hospital
                                                                                     Certification
Mehmet Bayram, M.D.                             1981         2006   Ob/Gyn                           3                  Ob/Gyn          100            12
Danny Benjamin, M.D.                            1983         2006   Ob/Gyn                           3                  Ob/Gyn          100            12
Pamela Bock, M.D.                               1994         2006   Ob/Gyn                           3                  Ob/Gyn          100            12
David Cantor, M.D.                              1983         2006   Ob/Gyn                           3                  Ob/Gyn          100            12
Cathy Chubb, M.D.                               1994         2006   Ob/Gyn                           3                  Ob/Gyn          100            12
Susanna Szelestey, M.D.                         1986         2006   Ob/Gyn                           3                  Ob/Gyn          100            12

*Institutions as listed in Part 1, Section 2.
**E.g., general gynecology, REI, oncology.
                                                                                                          72

SECTION D. ADDITIONAL TRAINEES: FELLOWS IN TRAINING

                                                                                Date Fellowship    At Inst.
Name                                             Subspecialty
                                                                                     Ends         1,2,3,4,5*
Bryant, Christopher                                  Gynecologic Oncology          6/30/10            1
Detti, Laura                                       Reproductive Endocrinology      6/30/07            1
Drennan, Kathryn                                    Maternal-Fetal Medicine        6/30/09            1
Friel, Laura                                        Maternal-Fetal Medicine        6/30/08            1
Goud, Pravin                                       Reproductive Endocrinology      6/30/08            1
Hanif, Farhan                                       Maternal-Fetal Medicine        6/30/08            1
                                                         Maternal-Fetal
Khalek, Nahla.                                                                     6/30/07            1
                                                       Medicine/Genetics
Louis, Judette                                      Maternal-Fetal Medicine        6/30/07            1
Mazaki-Tovi, Shali                                  Maternal-Fetal Medicine        6/30/09            1
Mittal, Pooja                                       Maternal-Fetal Medicine       6/30/07             1
Mitwally, Mohamed                                  Reproductive Endocrinology     6/30/007            1
Shah, Jay P.                                         Gynecologic Oncology          6/30/10            1
Solomon, Leigh                                       Gynecologic Oncology          6/30/08            1
* Institutions as listed in Part 1, Section 2.
                                                                                                                    73

SECTION E. ADDITIONAL TRAINEES: OB-GYN RESIDENTS FROM OTHER INSTITUTIONS OR
PROGRAMS WHO RECEIVE ANY TRAINING IN THIS PROGRAM
For Academic Year Ending:       6/30/06

                                                                                                    Hospital Used And
                          Level Of Ob-Gyn           Parent Institution or       Duration Of This
         Name                                                                                            Specific
                          Training*                      Program                  Assignment
                                                                                                     Assignment(S)**
                                                  Mt. Clemens General                              Maternal Fetal
Carrie Champine, D.O.             OBG-3                                     2
                                                  Hospital                                         Medicine
                                                  North Oakland Medical
Sujithra Jayaraj, M.D.            OBG-2                                     1                      Genetics
                                                  Center
Mohamad Mahmoud,                                                                                   Reproductive
                                  OBG-3           Oakwood Hospital          1
M.D.                                                                                               Endocrinology
                                                                                                   Maternal Fetal
Dennis Merski, D.O.               OBG-3           Henry Ford Horizon        1
                                                                                                   Medicine
                                                  Mt. Clemens General                              Maternal Fetal
Jennifer Nichols, D.O.            OBG-3                                     2
                                                  Hospital                                         Medicine
                                                                                                   Reproductive
Jessica Puckett, D.O.             OBG-3           Garden City Hospital      1
                                                                                                   Endocrinology
                                                  North Oakland Medical
Meena Shankar, MD                 OBG-2                                     1                      Genetics
                                                  Center
                                                  North Oakland Medical                            Reproductive
Lystra Wilson, MD                 OBG-3                                     1
                                                  Center                                           Endocrinology




* OBG-1, OBG-2, OBG-3, OBG-4, OBG-5
** Institutions As Listed In Part 1, SECTION 2.
                                                                                                            74

SECTION E. ADDITIONAL TRAINEES: OB-GYN RESIDENTS FROM OTHER INSTITUTIONS OR
PROGRAMS WHO RECEIVE ANY TRAINING IN THIS PROGRAM
For Academic Year Ending:

                                                                                             Hospital Used And
                          Level Of Ob-Gyn         Parent Institution or   Duration Of This
         Name                                                                                     Specific
                          Training*                    Program              Assignment
                                                                                              Assignment(S)**




* OBG-1, OBG-2, OBG-3, OBG-4, OBG-5
** Institutions As Listed In Part 1, SECTION 2.
                                                                                                                     75


SECTION F.           ADDITIONAL TRAINEES:           OTHER TRAINEES PER YEAR ASSIGNED TO THIS
PROGRAM

For Academic Year Ending:        June 30, 2006

Categories:        Family Practice Residents               Medical Students (LCME Approved Schools)
                   Surgical Residents                      Medical Students (Other)
                   Medical Residents                       Nurse Midwife Students
                   Pediatric Residents                     Nurse Practitioner Students
                   Emergency Medicine Residents            Others (Specify)

                                                  Length Of Assignment Per Individual
     Number               Category Of Trainee                                             At Institution 1, 2, 3, 4, 5*
                                                               (months)
        11              Family Practice                            1                                   1
                         Medicine and
         0                                                         1                                   1
                            Surgery
        12            Emergency Medicine                           1                                   2
                       Medical Students
       112             (LCME Approved)                             2                                   1
                             MS-3
                       Medical Students
        46             (LCME Approved)                             2                                   2
                             MS-3
                       Medical Students
        22             (LCME Approved)                             1                                   1
                             MS-4
        18               PA Students                               1                                   1
         4               PA Students                               1                                   2
                       Medical Students
         1                (Non LCME                                1                                   1
                           Approved)
*Institution as listed in Part 1, Section 2
                                                                                                                               76

SECTION G. ORGANIZED TEACHING ACTIVITIES
List all the regularly scheduled educational activities of this program, including teaching rounds, clinical case conferences,
gynecologic pathology conferences, interdepartmental conferences, specialty conferences, seminars, and other functions held
primarily for the benefit of your residents. Designate whether the activity is required (R), optional (O), or required of residents
only when they are on that particular service (RS). List them in the order of R, then RS, then O.

Please indicate those activities into which basic sciences (BS), genetics (G), ethics (E), and medical jurisprudence (MJ) are
integrated into these activities.

                             R/O/R       Frequency Per            Conducted Or Supervised
   Name Of Activity                                                                                   Indicate If Bs, G, E, Mj
                               s             Month                          By
     Grand Rounds              R               4                       Dr. Diamond                          BS, G, E, MJ
        Ob M&M                 R                 1                          Dr. Sorokin                     BS, G, E, MJ
       Gyn M&M                 R                  1                       Dr. McNeeley                            BS
Core Resident Lecture
                               R                 4                       Dr. Christensen                      BS, E, MJ
        Series
Ultrasound Conference         RS                 4                      Dr. Bahado-Singh                         G, E
      Gyn Rounds              RS               Daily                   Gynecology faculty                       BS, E
      Ob Rounds               RS               Daily                       MFM faculty                             G
Endocrine/IVF Division
                              RS                 1                         Dr. Diamond                          BS, E
      Conference
  Genetics Division
                              RS                  4                     Dr. Bahado-Singh                           G
      Conference
 Fetal Dysmorphology
                              RS                 1                      Dr. Bahado-Singh                        BS, G
        Rounds
   Speroff Rounds             RS                 4                      Endocrine faculty                       BS, E
   Fetal Heart Rate
                              RS                 4                          Dr. Sorokin                         BS, MJ
   Tracing Rounds
 Ob/Peds Conference           RS                 4               MFM and Neonatology fellows                    BS, E
 High Risk Conference         RS                 4                         MFM faculty                          BS, E
Oncology Tumor Board          RS                  3                         Dr. Morris                            BS
Anesthesia Conference         RS                 1              Sinai/Grace Anesthesia faculty                  BS, E
     Gynecology
                              RS                 1                Sinai/Grace Ob/Gyn faculty                    BS, E
     Conference
 Obstetric Conference         RS                 1                Sinai/Grace Ob/Gyn faculty                    BS, E
  MFM/Neonatology
                              RS                 1                Sinai/Grace Ob/Gyn faculty                    BS, E
     Conference
   Special Speaker            RS                 1                Sinai/Grace Ob/Gyn faculty                    BS, E
     Colposcopy
                              RS                  4                     Dr. Husain/Kmak                           BS
     Conference
    Journal Club               O                 1                           Dr. Jones                             G
       Wayne Day               R            1 per year                     Dr. Diamond                      BS, G, E, MJ
 PRB Summer Course                      Daily for 6 weeks                  Dr. Romero                             BS
                                      1 day per week for 12
    Genetics Course            R                                           Dr. Romero                             BS
                                              weeks
Hysteroscopy Seminar           R       2 hours, 1 per year                   Dr. Kmak                             BS
   Implanon Training           R       3 hours, 1 per year                   Dr. Kmak                             BS
                                                                                                                          77

SECTION H. RESEARCH AND PUBLICATIONS
1.   List not more than 10 research projects conducted within the past 3 years in the program by faculty or residents
     and indicate with an asterisk those projects in which residents participated. Limit publications to projects carried
     out primarily in your program.

     Tinnakorn Chaiworapongsa, Jimm Espinoza, JYH Kae Nien, Luis Goncalves, Samuel Edwin, Karina Richani, Eleazar Soto,
     Joaquin Santolaya, Chong Jai Kim, Yeon Mee Kim, Roberto Romero. Preeclampsia and SGA are Characterized by Low
     Concentrations of a Novel Factor Involved in Angiogenesis and Endothelial Cell Function: SVEGFR-2. Presented at the
     SMFM 26th Annual Meeting, February 1-3, 2006, Miami Beach, FL.

     Caroline D’Souza MD, Jerrie S Refuerzo MD, Natalia Camacho MD, Jose R Duncan MD, Jyothi Nichanemetla MD, Sean C
     Blackwell MD, Yoram Sorokin, MD. Perinatal Outcomes of Women with Diabetic Ketoacidosis During Pregnancy.
     Presented at the SMFM 26th Annual Meeting, February 1-3, 2006, Miami Beach, FL.

     Jose R Duncan MD, Jerrie S Refuerzo MD, Natalia Camacho MD, Jyothi Nichanametla MD, Sean C Blackwell MD, Robert
     J Sokol MD, Yoram Sorokin MD. The Effect of Glyburide on Pregnancy Outcomes in Morbidly Obese Women with
     Gestational Diabetes. Presented at the SMFM 26th Annual Meeting, February 1-3, 2006, Miami Beach, FL.

     Michael Mahoney MD, Julie S Moldenhauer MD, Marjorie C Treadwell MD. Uterine Rupture and Subsequent Pregnancy
                                       th
     Outcome. Presented at the SMFM 26 Annual Meeting, February 1-3, 2006, Miami Beach, FL.

     Ammar Shammaa MD, Jerrie S Refuerzo MD, Sean C Blackwell MD, Yoram Sorokin MD. Maternal Outcomes of Pregnant
     Women with Asthma Exacerbation Requiring Intensive Management in a Critical Care Setting. Presented at the SMFM
       th
     26 Annual Meeting, February 1-3, 2006, Miami Beach, FL.

     Yi Li, MD, PhD, Bernard Gonik MD. Is Congenital Syphilis Really Congenital Syphilis? Presented at the SGI Annual
     Meeting, March 22-25, 2006, Toronto, Canada.

     Michael Mahoney, MD, Roderick Hume MD, Suzanne Jacques MD, Tressa Orthmeyer MS, Marjorie Treadwell MD.
     Maternal Jeopardy: Hydramnios, Hyperemesis, & Hypertension in Twin Pregnancy-Complete Hydatidiform Mole and
     Female Co-Twin with Beckwith Weidemann Syndrome. Presented at the ACMG Annual Clinical Genetics Meeting, March
     23-26, 2006, San Diego, CA.

     Dana Ambler, Rahi Victory, Mazen Abdallah, Michael P Diamond, Elizabeth E Puscheck, Jay M Berman. Should ruptured
                                                                                    nd
     tubal ectopic pregnancies be managed laparoscopically? Presented at the ASRM 62 Annual Meeting, October 21-25,
     2006, New Orleans, LA.

     ME Abdallah, R Victory, DR Ambler, MP Diamond, EE Puscheck, JM Berman. Reducing unnecessary surgical
     interventions: Risk factors for laparoscopic conversion to laparotomy in the management of ectopic pregnancies.
     Presented at the ASRM 62nd Annual Meeting, October 21-25, 2006, New Orleans, LA.

     Mazen E Abdallah, Rahi Victory, Dana R Ambler, Michael P Diamond, Elizabeth E Puscheck, Jay M Berman. Reducing
     unnecessary surgical interventions: Risk factors for laparoscopic conversion to laparotomy in the management of ectopic
                                            th
     pregnancy. Presented at the AAGL 35 Annual Meeting, November 6-9, 2006, Las Vegas, NV.

      *
                                                                                                                            78


    2.   List not more than 10 representative publications of the past three years by members of the active teaching
         staff or residents in the training program. Please supply titles and complete journal references. Asterisk
         those publications in which residents participated and underline the names of residents. Limit publications
         to projects carried out primarily in your program.

*Alpay Z, Ozgonenel MS, Savasan S, Buck S, Saed GM, Diamond MP. Altered in vitro immune response against hypoxia-
treated normal peritoneal fibroblasts. Fertil Steril (Epub, Nov 15, 2006).

*Zeynep Alpay, Melike S. Ozgonenel, Sureyya Savasan, Steven Buck, Ghassan M. Saed, Michael P. Diamond. Possible Role
of Natural Immune Response against Altered Fibroblasts in the Development of Post-Operative Adhesions. American Journal
of Reproductive Immunology 55:420-427, 2006.

*Zeynep Alpay, MD, Ghassan M. Saed, PhD, and Michael P. Diamond, MD. Female Infertility and Free Radicals: Potential
Role in Adhesions and Endometriosis. J Soc Gynecol Investig 13(6):390-398, September 2006.

*Goncalves LF, Nien JK, Espinoza J, Kusanovic JP, Lee W, Swope B, Soto E, Treadwell MC, Romero R. What does 2-
dimensional imaging add to 3- and 4- dimensional imaging add to 3- and 4- dimensional obstetric ultrasonography? J
Ultrasound Med. 2006 Jun;25(6):691-9.

*Nien JK, Yoon BH, Espinoza J, Kusanovic JP, Erez O, Soto E, Richani K, Gomez R. Hassan S, Mazor M, Edwin S, Bahado-
Singh R, Romero R. A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for
imminent preterm delivery. Am J Obstet Gynecol. 2006 Oct;195(4):1025-30.

*Richani K, Romero R, Kim YM, Cushenberry E, Soto E, Han YM, Espinoza J, Kim CJ. Tissue microarray: an effective high-
throughput method to study the placenta for clinical and research purposes. J Matern Fetal Neonatal Med. 2006
Aug;19(8):509-15.

*Richani K, Romero R. Soto E, Nien JK, Cushenberry E, Kim YM, Espinoza J, Kim CJ. Genetic origin and proportion of basal
plate surface-lining cells in normal and abnormal pregnancies. Hum Pathol. 2006 Oct 20; [Epub ahead of print]

*Santolaya-Forgas J, Mahoney M, Abdallah M, Duncan J, Delgado A, Stang P, Deleon J, Castracane VD. Fetal Gender and
Maternal Serum Screening Markers. Genet Med 2006 Oct;8(10):671-672.
                                                                                                                          79

SECTION I. MEDICAL LIBRARY FACILITIES
1.   Describe the medical library facilities and services available to the residents.

           There is a substantial on-line e-library that can be accessed through the internet. The
           Shiffman library that functions as the WSU medical school library is fully available for
           resident use.

           Additional services provided include database searching, free departmental photocopier
           for library materials, end-user training in health sciences literature searching and
           evaluation in Microsoft Office applications. Interlibrary loan services are available to
           obtain materials that are not included in the Medical Library's own collection. Items
           owned by other Detroit Medical Center Libraries are usually obtained in less than 24
           hours.

            Audiovisual equipment is available for presentations at all hospitals, and includes the
            availability for computer generated presentations and LCD projection equipment.
            Additionally, a laptop is provided for residents’ presentations when the resident trainee
            does not possess a laptop computer.


2.   Do residents have computer assisted literature search available?           YES ( X ) NO ( )

     If no, explain.




3.   Do residents have Internet access?       YES ( X ) NO ( )

     If no, explain




SECTION J. RESIDENCY OUTLINE
Please submit in block form an outline of each resident assignment. Indicate the periods of time in each block that are
appropriate for your program. Please identify with an asterisk the 12 months of senior resident experience. On this diagram
each block represents one month.

If the rotations are not uniform for each resident then submit a separate block diagram for each resident experience (see
Program Requirements V.A.3.b).


LEVEL OBG -1
Specific
                       GYN      U/S    FLOAT      L&D   Genetics MFM      GYN       ER      GYN     L&D     L&D      L&D
Assignment
Institution
                         2        1       1        1        1        1      1           5    1       1        1       2
1,2,3,4,5**
                                                                                                                                         80

LEVEL OBG -2
Specific                                                                                                       Family
                      OB       ONC       FLOAT          REI      OB     OB     GYN    LRC          OB                    MFM    GYN
Assignment                                                                                                    Planning
  Institution
                       1           4            2          1     1       1      2         1         2            1        1         1
  1,2,3,4,5**

LEVEL OBG -3
Specific                               URO-
                    MFM      OB                     ELECTIVE    GYN     GYN    OB    OB       GYN        OB      FLOAT    GENETICS
Assignment                             GYN
Institution
                      1       1         1             ANY        1       2     2     1         1         1           2          1
1,2,3,4,5**


LEVEL OBG -4
Specific                                                                GYN                              SYNERGY         GYN
                     OB*     GYN*       GYN*          AMB*     FLOAT*          OB*   FLOAT*        OB*                              Gyn*
Assignment                                                              ONC*                             MEDICAL*        ONC*
Institution
                       1       3            3          1         1       5      1        1          1           6         5          1
1,2,3,4,5**

** Institutions as listed in Part 1, Section 2.
                                                                                                                  81

SECTION K. INSTITUTIONAL DATA
Use the institution numbers from Part 1, Section 2.

Statistics for 12 months     From: July   2005                                    To: June   2006
1.   Obstetrics - Profile of Program)

     Use institution numbers as listed in Part 1, Section 2.

     Total In Program                                           1             2          3          4   5    Total
     Outpatients (new)                                   2960          336                                  3296
     Outpatients (total visits)                          24925         2151                                 27076
     Total deliveries                                    5203          1989                                 7192
     Cesarean deliveries - total                         1391          527                                  1918
     Cesarean deliveries - primary                       1094          397                                  1491
     C-Delivery rate                                     27 percent 26 percent
     VBAC                                                204           50                                   254
     Breech delivered vaginally*                         39            19                                   58
     Forceps deliveries                                  23            47                                   70
     Vacuum (extractions) deliveries                     109           100                                  209
     Multifetal delivered vaginally                      56            15                                   71
     Pregnant diabetics (admitted/discharged) Type I,
                                                         233           72                                   305
     II and gestational
     PIH & chronic hypertensive patients
                                                         587           204                                  791
     (admitted/discharged)
     Admissions - 3rd trimester bleeding                 23            18                                   41
     Low birth weight infants (500-2500 grams)           836           296                                  1132
     Surgical Procedure on antenatal patients            No hospital    no hospital
     (excluding ectopic pregnancies)                     data          data
     Cardiac disease in pregnancy                        86            30                                   116
     percent of obstetric patients available for
                                                         99            99
     resident education

     *Include in term advanced labor, fetal demise, pre-viable infant, second twin.
                                                                                                                            82
2.   Gynecology Profile of Program

     Procedures to be counted only for patients on the gyn service including inpatients and outpatients. Use institution
     numbers as listed in Part 1, Section 2.

     Total In Program                                        1            2             3         4          5        Total
     Total major gynecologic operations (a)                2885         1593          1547                           6025
     Total minor gynecologic operations (a)                722           320          101                            1143
     Major surgical procedures for invasive gyn
                                                           131           19             0                            150
     neoplasia
     Abdominal hysterectomies (including those with
                                                           1944         1081          933                            3958
     colporrhaphy)(b)
     Vaginal hysterectomies (including those with
                                                           265*         243*          301*                           809
     colporrhapy) (c)
     Surgery for urinary incontinence (vaginal or
     abdominal) and reconstructive pelvic procedures       137           10           185                            332
     (f)
     Number of operative laparoscopic procedures
                                                           495           184          161                            840
     (excluding tubal sterilization) (d)
     Surgical sterilizations (including postpartum and
                                                           502           390            92                           984
     interval)
     Percent of gynecologic patients utilized for
                                                            99           95             75                           269
     resident education
     Outpatients (new)                                     2628          725            0                            3353
     Outpatient (total visits)                            10319         2818            0                            13137
     * These numbers are from the DMC. They are not able to separate vaginal hysterectomies from other types of vaginal
     surgery.

     a.   Defined as follows:
          Major surgical procedures: The number of patients who have a surgical procedure which involves entering the
          peritoneal space, or which involves extensive dissection or excision (hysterectomy, laparoscopic sterilization,
          laparoscopy, colporrhaphy, vulvectomy, adnexectomy fistula repair, urethropexy, etc.).

          Minor surgical procedures: The number of patients who have a surgical procedure not qualifying as a major
          procedure (d&c, hysteroscopy, suction curettage, conization, bartholin duct marsupialization, etc.).

     b.   Include abdominal hysterectomies for invasive gyn neoplasia listed in #3.

     c.   Include lavh in both #5 and #7.

     d    Include procedures also listed under vaginal hysterectomy in #5 when a colporrhaphy was done for urinary stress
          incontinence.

3.   Primary and Pre Schedule:

                                                                      Rotational Grid
           Institution           Mo. OBG-1                Mo. OBG-2                   Mo. OBG-3            Mo. OBG-4
     1 Hutzel Women’s
                                      9                          8                           9                   7
     Hospital
     2 Sinai-Grace                    2                          3                           3                   0
     3 Huron Valley-
                                      0                          0                           0                   2
     Sinai
     4 Detroit Receiving
                                      1                          0                           0                   0
     Hospital
     Karmanos Cancer
                                      o                          1                           0                   2
     Institute
     5 Saginaw                        0                           0                          0                   1
                                                                                                                        83

4.   Primary and Preventive Medical Services

                                       Location:
                                                                                       Half Day    Approximate Number of
                                      Institution     Total Visits    New Patient
             Clinic                                                                  Sessions Per Patients Per Resident Per
                                     1,2,3,4,5 Pvt.    Per Year      Visits Per Year
                                                                                        Week               Session
                                     Office, Clinic
Obstetrics                       1                    24925          2960            9               (see Continuity)
High-Risk OB                     1                    4136           No data         3               12
Gynecology                       1                    8924           1997                            (see Continuity)
Obstetrics                       2                    2487           336             6               (see Continuity)
Gynecology                       2                    2818           725              6              (see Continuity)
Urogynecology                    Pvt office           896            160             6               8
Breast                           N/A                  0              0               0               0
Colposcopy                       1                    1391           631             3               8
Gynecologic Oncology             1                    4400           1500            9               15
Repro/ Endo/ Infertility         Pvt office           3800           200             6               8
Pediatric /Adolescent (<18
                                 1                    4500           1200             9              (see Continuity)
years)
Continuity*                      1                    7960           No data         9               10
Other (Ambulatory
                                 Pvt office           2500           300             2               10
Gyn/Berman)
Other (Hendrix/Menopause)        Pvt Office           580            85              1               11
Other (Malone/Menopause)         1                    450            50              1               15

* Be sure to describe in the (Narrative Part 2, Section A, #14) the continuity of care experience for residents.
                                                                                                                        84

SECTION L. CONTENT OF THE CURRICULUM
Indicate the typical level of education achieved by all residents who complete this program.

                                                               Perform And/Or                  Do Not Perform Or Assist But
                           Obstetrics                                              Assist
                                                                   Manage                         Learn The Principles of
Obstetric Procedures
Delivery, spontaneous                                                 X
Episiotomy, 3rd or 4th degree                                         X
Delivery, forceps                                                     X
Delivery, vacuum extractor                                            X
Delivery, vaginal breech, including breech second twin                X
Delivery, cesarean                                                    X
Cesarean hysterectomy                                                 X
Cervical cerclage                                                     X
External cephalic version                                             X
Amniocentesis for genetic studies, lung maturity or
                                                                      X
infection
Antepartum testing (NST, CST, BPP)                                    X
Chorionic villus sampling                                                                                   X
Percutaneous umbilical cord blood sampling (PUBS)                                                           X
Sonography, abdominal                                                 X
Sonography, vaginal                                                   X
Regional analgesia (spinal, saddle, epidural, caudal)                                                       X
Immediate care of the newborn, including resuscitation                                                      X
                                          Management Of Pregnant Patients With
Cardiac disease                                                                        X
Chronic hypertensive disease                                          X
Connective tissue disease                                             X
Diabetes mellitus                                                     X
Fetal growth restriction                                              X
Gestational trophoblastic disease                                                      X
Isoimmunization                                                                        X
Pregnancy induced hypertension, preeclampsia, eclampsia               X
Major fetal anomalies                                                                  X
Preterm labor                                                         X
Preterm rupture of membranes                                          X
                                                                                                                   85

                                                         Perform And/Or                  Do Not Perform Or Assist But
                         Gynecology                                          Assist
                                                             Manage                        Learn The Principles Of
Gynecologic Surgery External Genitalia
Simple vulvectomy                                                  X
Perineorrhaphy                                                     X
Vagina, Repair of
Rectovaginal fistula                                                           X
Suburethral diverticulum                                                       X
Ureterovaginal fistula                                                         X
Urethrovaginal fistula                                                         X
Vesicovaginal fistula                                                          X
Posterior colpotomy                                                X
                                                        Cervix
Colposcopy                                                         X
Ablative therapy: cautery, cryosurgery, laser                      X
Conization: cold knife, laser, LEEP                                X
Trachelectomy                                                                  X
                                                        Uterus
Abdominal hysterectomy                                             X
D&C                                                                X
Hysteroscopy, diagnostic                                           X
Hysteroscopy, operative                                            X
Myomectomy                                                         X
Suction curettage                                                  X
Vaginal hysterectomy                                               X
                                                        Adnexa
Oophorectomy                                                       X
Ovarian cystectomy                                                 X
Salpingectomy                                                      X
Salpingostomy                                                      X
Tubal reconstruction                                                           X
                                  Pelvic Floor Dysfunction, Diagnosis And Management:
Surgery for stress incontinence, abdominal                                     X
Surgery for stress incontinence, vaginal                           X
Urodynamic evaluation, cystoscopy, urethoscopy                     X
Pessary insertion                                                  X
                                                       Repair Of
Bladder injury                                                     X
Cystocele                                                          X
Enterocoele                                                        X
Rectocele                                                          X
Uterine prolapse                                                   X
                                  Reproductive Endocrinology & Infertility Management:
Assisted reproductive technologies                                             X
                                                                                                                  86

                                                             Perform And/Or             Do Not Perform Or Assist But
                          Gynecology                                           Assist
                                                                 Manage                   Learn The Principles Of
Diagnostic laparoscopy                                              X
Endometriosis: hormonal, excisimal, ablative                        X
Operative laparoscopy                                               X
Ectopic pregnancy - surgical or medical                             X
Hysterosalpingograms (Saline infusion
                                                                    X
sonohysterograms)
Hirsutism/virilization                                                           X
Induction of ovulation                                                                               X
Infertility                                                         X
Primary/secondary amenorrhea                                        X
Sexual Dysfunction                                                               X
Vaginal ultrasound                                                  X
                                          Gynecologic Oncology Management: Surgery:
Bowel resection and anastomosis                                                  X
Para-aortic and pelvic lymph node excision                                       X
Radical hysterectomy                                                             X
Vulvectomy                                                          X
Repair of bowel injury (small or large)                                          X
Repair of vessel injury (hypogastric artery ligation)                            X
Surgical exposure (iliac vessels, ureter, obturator nerve)          X
Ureteral repair                                                                  X
Dehiscence/evisceration management                                               X
Evacuation of retroperitoneal hematoma                                           X
Brachytherapy                                                                    X
Cancer chemotherapy                                                              X
                                                        Family Planning
IUD counseling and insertion                                        X
Diaphragm insertion                                                 X
Induced Abortion: medical or surgical, including
                                                                    X
complications
                                                         Breast Disease
Biopsy/fine needle aspiration                                                                        X
Mammogram interpretation                                                                             X

                                                              Perform And/Or            Do Not Perform Or Assist But
                          Critical Care                                        Assist
                                                                  Manage                   Learn The Principles of
Arterial line insertion                                              X
General anesthesia                                                                                   X
Hyperalimentation                                                                X
PA catheter insertion                                                            X
Paracentesis                                                                                         X
Subclavian and internal jugular line insertion                                                       X
Thoracentesis                                                                                        X
Ventilator management                                                            X
                                                                                                     87


                                                Perform And/Or            Do Not Perform Or Assist But
                Primary Ambulatory Care                          Assist
                                                    Manage                   Learn The Principles of
Preventive Medicine
Patient safety                                        X
Substance abuse                                       X
Smoking cessation                                     X
Nutritional counsel                                   X
Lipid disorders                                       X
Immunizations                                         X
Fitness counseling                                    X
Domestic violence                                     X
Common pediatric and adolescent disorders             X
Common medical emergencies                            X
Sigmoidoscopy                                                                          X
Infectious Diseases
ENT disorders                                                      X
HIV infection                                                      X
Sexually transmitted diseases                         X
Urinary tract                                         X
Respiratory infections                                X
Chronic Medical Diseases
Arthritis (other rheumatologic and autoimmune
                                                      X
diseases)
Thyroid diseases                                      X
Asthma (and other respiratory disorders)              X
Cardiovascular disease and hypertension                                                X
Dermatologic disorders                                X
Diabetes mellitus                                     X
Gastrointestinal disorders:                           X
Irritable bowel syndrome                                           X
Gastroesophageal reflux disease                       X
Inflammatory bowel disease                                         X
Neurological disorders and headaches                  X
Hematological disorders                                            X
Low back pain and musculoskeletal disorders           X
Renal disorders                                                    X
Behavioral Medicine
Anxiety                                               X
Depression                                            X
Eating disorders                                                                       X
Obesity                                               X
Substance abuse                                                    X
                                                                                                           88

                  SECTION M. STATUS OF GRADUATE TRAINING PROGRAMS


                  Name of Hospital: Harper-Hutzel                City:    Detroit                State:    Michigan


                                                  House Staff (Resident) Positions
                                                  Total # of     Maximum #            Number filled
  Graduate Training          Does institution                    rotating at
      Program                                    positions in
                             participate in an                       this       Foreign    Other    Total
                                                   training
                           accredited program?                  institution at graduates graduates Filled
                                                  program
                                                                  one time
Initial Year of Graduate
Education (Transitional            Y                 18             1.5              7      11            18
Year)
Allergy and
                                    Y                 3                              2       1             3
Immunology
Anesthesiology                     Y                 40              18             33       7            40
Colon and Rectal
Surgery
Dermatology                         Y                11             6.5              0      11            11
Dermatopathology
Emergency Medicine                 Y                 66              7              16      50            66
Family Practice                     Y                29                             22       7            29
Internal Medicine                   Y               158              48             128     30            158
Neurological Surgery                Y                 5              4               1       4             5
Neurology                          Y                 16              6              11       5            16
Nuclear Medicine
Obstetrics-Gynecology              Y                 44              27             17      19            36
Ophthalmology                      Y                 21              14              0      21            21
Otolaryngology                     Y                 16              6               0      16            16
Pathology-Anat. Clin.              Y                 12              9               9       3            12
Pathology-Forensic
Pathology-
Neuropathology
Pathology-Blood
Banking
Pediatrics                         Y                 84              7              46      38            84
Pediatric Cardiology               Y                  5                              4       1             5
Pediatric Surgery                  Y                  2                              0       2             2
Physical Med. and
                                   Y                 15                              4      10            14
Rehab.
Plastic Surgery                    Y                  6              3               2       4             6
Preventive Med.-
General
Prev. Med.-Aerospace
Med.
Prev. Med.-
                                    Y                 4                              2       2             4
Occupational Med
Prev. Med.-Public
Health
                                                                                                 89

                                             House Staff (Resident) Positions
                                             Total # of     Maximum #            Number filled
  Graduate Training     Does institution                    rotating at
      Program                               positions in
                        participate in an                       this       Foreign    Other    Total
                                              training
                      accredited program?                  institution at graduates graduates Filled
                                             program
                                                             one time
Psychiatry                     Y                 27               1           21         6      27
Psychiatry-Child               Y                 6                          2           1       3
                                                                    90


Radiology with special
competence in Nuclear
Radiology
Radiology-Diagnostic             Y   38     21     3     35    38
Radiology-Therapeutic            Y   7      7      1     6     7
Surgery                          Y   59     20     9     50    59
Thoracic Surgery                 Y   6      4.5    3     3     6
Urology                          Y   18     4      7     11    18
               Total Positions       756   214.5   354   744
                                                                                                           91

                  SECTION M. STATUS OF GRADUATE TRAINING PROGRAMS

                  Name of Hospital: Sinai-Grace Hospital         City:    Detroit                State:    Michigan

                                                  House Staff (Resident) Positions
                                                  Total # of     Maximum #            Number filled
  Graduate Training          Does institution                    rotating at
      Program                                    positions in
                             participate in an                       this       Foreign    Other    Total
                                                   training
                           accredited program?                  institution at graduates graduates Filled
                                                  program
                                                                  one time
Initial Year of Graduate
Education (Transitional            Y                  18             13              7      11            18
Year)
Allergy and
                                    Y                  3                             2       1             3
Immunology
Anesthesiology                     Y                  40             5              33       7            40
Colon and Rectal
Surgery
Dermatology                         Y                 11                             0      11            11
Dermatopathology
Emergency Medicine                 Y                  66             26             16      50            66
Family Practice                     Y                 29             25             22       7            29
Internal Medicine                   Y                 158            51             128     30            158
Neurological Surgery                Y                  5                             1       4             5
Neurology                          Y                  16                            11       5            16
Nuclear Medicine
Obstetrics-Gynecology              Y                  44             8              17      19            36
Ophthalmology                      Y                  21             2               0      21            21
Orthopaedic Surgery                Y                  40             7               4      36            40
Otolaryngology                     Y                  16                             0      16            16
Pathology-Anat. Clin.              Y                  12                             9       3            12
Pathology-Forensic
Pathology-
Neuropathology
Pathology-Blood
Banking
Pediatrics                         Y                  84                            46      38            84
Pediatric Cardiology               Y                   5                             4       1             5
Pediatric Surgery                  Y                   2                             0       2             2
Physical Med. and
                                   Y                  15            6.5              4      10            14
Rehab.
Plastic Surgery                    Y                   6             .5              2       4             6
Preventive Med.-
General
Prev. Med.-Aerospace
Med.
Prev. Med.-
                                    Y                  4             4               2       2             4
Occupational Med
Prev. Med.-Public
Health
Psychiatry                          Y                 27             9              21       6            27
                                                                                                 92

                                             House Staff (Resident) Positions
                                             Total # of     Maximum #            Number filled
  Graduate Training     Does institution                    rotating at
      Program                               positions in
                        participate in an                       this       Foreign    Other    Total
                                              training
                      accredited program?                  institution at graduates graduates Filled
                                             program
                                                             one time
Psychiatry-Child               Y                  6                           2          1       3
                                                                     93


Radiology with special
competence in Nuclear
Radiology
Radiology-Diagnostic             Y   38     9.5    3     35    38
Radiology-Therapeutic            Y   7             1     6     7
Surgery                          Y   59     6      9     50    59
Thoracic Surgery                 Y   6             3     3     6
Urology                          Y   18            7     11    18
               Total Positions       756   172.5   354   390   744
                                                                                                           94

                  SECTION M. STATUS OF GRADUATE TRAINING PROGRAMS

                  Name of Hospital: Huron Valley-Sinai Hospital   City:    Commerce Twp          State:    Michigan

                                                  House Staff (Resident) Positions
                                                  Total # of     Maximum #            Number filled
  Graduate Training          Does institution                    rotating at
      Program                                    positions in
                             participate in an                       this       Foreign    Other    Total
                                                   training
                           accredited program?                  institution at graduates graduates Filled
                                                  program
                                                                  one time
Initial Year of Graduate
Education (Transitional            Y                  18                           7        11            18
Year)
Allergy and
                                    Y                  3                           2         1            3
Immunology
Anesthesiology                     Y                  40              2           33         7            40
Colon and Rectal
Surgery
Dermatology                         Y                 11                           0        11            11
Dermatopathology
Emergency Medicine                 Y                  66              2           16        50            66
Family Practice                     Y                 29              1           22         7            29
Internal Medicine                   Y                 158                         128       30            158
Neurological Surgery                Y                  5                           1         4            5
Neurology                          Y                  16                          11         5            16
Nuclear Medicine
Obstetrics-Gynecology              Y                  44             1.5          17        19            36
Ophthalmology                      Y                  21                           0        21            21
Orthopaedic Surgery                Y                  40                           4        36            40
Otolaryngology                     Y                  16                           0        16            16
Pathology-Anat. Clin.              Y                  12                           9         3            12
Pathology-Forensic
Pathology-
Neuropathology
Pathology-Blood
Banking
Pediatrics                         Y                  84                          46        38            84
Pediatric Cardiology               Y                   5                           4         1            5
Pediatric Surgery                  Y                   2                           0         2            2
Physical Med. and
                                   Y                  15                           4        10            14
Rehab.
Plastic Surgery                    Y                   6                           2         4            6
Preventive Med.-
General
Prev. Med.-Aerospace
Med.
Prev. Med.-
                                    Y                  4                           2         2            4
Occupational Med
Prev. Med.-Public
Health
Psychiatry                          Y                 27                          21         6            27
                                                                                                 95

                                             House Staff (Resident) Positions
                                             Total # of     Maximum #            Number filled
  Graduate Training     Does institution                    rotating at
      Program                               positions in
                        participate in an                       this       Foreign    Other    Total
                                              training
                      accredited program?                  institution at graduates graduates Filled
                                             program
                                                             one time
Psychiatry-Child               Y                  6                           2          1       3
                                                                   96


Radiology with special
competence in Nuclear
Radiology
Radiology-Diagnostic             Y   38          3     35    38
Radiology-Therapeutic            Y   7           1     6     7
Surgery                          Y   59          9     50    59
Thoracic Surgery                 Y   6           3     3     6
Urology                          Y   18          7     11    18
               Total Positions       756   6.5   354   390   744
                                                                                                                                                              97

SECTION N. RESIDENT CASE LOGS

Retrieve the appropriate reports from the Resident Case Log System and enter the required information for the most recent class of graduates.

1.   Resident experience in obstetrics*

                                 Spont                   Vac           C-      Vag Breech               Multi Fetal        Low Birth        Antenatal
              Resident                      Forceps                                                                                                     Amnio
                                Delivery               Delivery     Delivery    Delivery                 Delivery           Weight           Surgery
     Mazen Abdallah, MD        371          4         13           125       3                     9                  34               23               11
     Cristina Alfieri, MD      210          9         18           103         1                   9                  20               10               5
     Natalia Camacho, MD       326          5         14           219         0                   17                 37               1                46
     Caroline D’Souza, MD      419          4         17           155         0                   11                 33               9                12
     Alberto Delgado, MD       128          3         14           71          3                   1                  0                13               27
     Jose Duncan, MD           280          2         20           199         9                   7                  43               3                23
     Todd Kraemer, MD          286          14        13           240         0                   15                 46               23               21
     Michael Mahoney, MD       215          6         13           162         10                  15                 21               18               20
     Hemamalini Pilla, MD      313          4         13           247         4                   12                 16               4                13
     Ammar Shammaa, MD         403          4         27           253         4                   19                 35               15               8
     Perkin Stang, MD          292          10        18           172         3                   19                 55               2                16


     Total                     3243         65        180          1946        37                  134                340              121              202
     Mean**                    295          6         16           177         3                   12                 31               11               18
     Assist***                 774          11        38           520         7                   17                 64               38

     *   Resident experience numbers should be the total of "surgeon" cases for the first 8 categories. For the category amniocentesis, include surgeon and a
         assistant procedures.
     ** Do not include in mean anyone with less than 4 years of training in Obstetrics-Gynecology.
     *** Combine numbers for all residents listed.
                                                                                                                                                         98

2.   Resident experience in gynecology*

                           Abd                      Incon Surg            Laposc     Hysteros       Induced Surg          Vag Ultra   Endo Inf     Uro         Surg
         Resident               Vag Hyst Laparotomy                                           Coniz                                                Gyn
                           Hyst                      Pelv Floor            Surg       copy            Abort steril         Sound       Surg                   Inv Ca
Mazen Abdallah, MD         48     17         62             25           80         30          3       16        64      91          35         50           68
Cristina Alfieri, MD       47     18         23             20           20         29          8       7         25      26          33         32           29
Natalia Camacho, MD        30     14         14             14           13         22          4       0         35      94          9          11           16
Caroline D’Souza, MD       87     18         43             22           42         73          20      14        59      31          0          27           25
Alberto Delgado, MD        72     32         13             33           29         35          20      11        38      26          6          27           41
Jose Duncan, MD            60     10         55             3            40         42          10      33        79      83          26         26           73
Todd Kraemer, MD           47     21         18             16           15         34          11      3         60      42          16         32           25
Michael Mahoney, MD        63     12         31             16           26         47          17      21        54      78          4          26           23
Hemamalini Pilla, MD       78     25         70             17           31         43          5       35        59      76          0          12           25
Ammar Shammaa, MD          83     19         55             19           41         75          17      29        105     67          42         36           33
Perkin Stang, MD           109    26         72             15           72         75          30      19        111     148         101        25           84


Total                      724    212        456            200          409        505         145     188       689     762
Mean**                     66     19         41             18           37         46          13      17        63      69
Assist***                  149    24         151            45           86         118         45      30        173     37

*   Resident experience numbers should be the total of "surgeon" cases for the first 10 categories. For categories beginning with "Endo Inf Surg", copy the
    total number of procedures.
** Do not include in the mean anyone with less than 4 years in the program.
*** Combine numbers for all residents listed.
                                                                                                                             99

3.   Resident experience in primary and preventive medicine*

             Resident        HTN or Cv Diabetes Thyroid Derm Gastro Respir Breast Age >60 Behav Immun Ped. Adol HCM Other
     Mazen Abdallah, MD      80          53        6         6     33       43    1     81    12    0     56    87    935
     Cristina Alfieri, MD    74          84        24        21    48      66     10    56    21    2     69    177   718
     Natalia Camacho, MD 288             283       130       4     28       221   34    97    12    19    11    367   164
     Caroline D’Souza, MD 59             119       25        19    50       26    71    60    60    3     83    486   938
     Alberto Delgado, MD     52          35        1         19    22       24    2     0     5     0     3     54    64
     Jose Duncan, MD         241         226       45        25    79       94    54    94    158   41    45    144   1139
     Todd Kraemer, MD        36          48        0         0     26      9      13    136   61    0     23    176   1442
     Michael Mahoney, MD 201             128       42        39    77      138    41    48    120   63    79    223   77
     Hemamalini Pilla, MD    43          37        15        12    38       18    24    6     7     7     22    28    162
     Ammar Shammaa, MD 121               81        20        28    56      35     13    7     62    9     10    110   1752
     Perkin Stang, MD        155         96        38        5     37      38     43    191   60    33    75    169   1787


     Total                   1350        1190      340       172   461      669   305   695   566   177   420   1934 8243
     Mean**                  123         108       34        17    46       67    31    70    57    18    42    193   824

     *    Copy total number of visits recorded in the Resident Case Logs.
     **   Do not include in mean anyone with less than 4 years in the program.

				
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