Subspecialities in Obstetrics and Gynecology
Junior residents (PGY-1 and PGY-2) are responsible for the initial evaluation and management of patients presenting to the labor and delivery unit. Once the patient is admitted, residents of all levels are actively involved in the management (antepartum, intrapartum and postpartum). The senior residents play a supervisory role in the management of normal intrapartum/postpartum obstetrics and uncomplicated cesarean deliveries. The senior residents also take a lead role in operative vaginal deliveries and complicated cesarean deliveries.
Experience in operative gynecology begins at the PGY-1 level with gradually increasing responsibility and exposure throughout the four years. Operative gynecologic procedures performed by the PGY-1 resident include dilatation and curettage, diagnostic and operative hysteroscopy, diagnostic laparoscopy, laparoscopic tubal sterilization, and minor operative laparoscopic surgeries. The PGY-2 resident is involved in similar cases, with greater involvement in operative hysteroscopy and operative laparoscopy. Minor laparotomies are also introduced at this level. PGY-3 and PGY-4 residents perform most laparotomies and vaginal surgeries, along with the more difficult and complicated laparoscopies.
Maternal Fetal Medicine
The residents on the Maternal Fetal Medicine (MFM) service are responsible for the assessment and management of all patients admitted for inpatient antepartum care. During this rotation, residents perform amniocentesis, assist in complicated obstetrical procedures, receive additional hands-on ultrasound training, and serve as consultants under the supervision of the MFM faculty physicians. In addition to managing the inpatient MFM service, residents attend weekly Perinatal conferences and high-risk clinic. The high-risk clinic is a unique experience where residents have the opportunity to evaluate patients and develop management plans with the Chair and MFM faculty. The rotation allows residents to become comfortable managing pregnancies complicated by preterm labor, preterm premature rupture of membranes, intrauterine growth restriction, diabetes, hematologic disease and many other high-risk conditions.
The Division of Gynecologic Oncology at NYU Winthrop Hospital consists of four attending gynecologic oncologists. The group has several ongoing trials and is an NCI-funded cooperative clinical trials group for gynecologic oncology patients.
The oncology service performs 500 major surgeries per year including many robotic cases each week. During the rotation, emphasis is placed on disease pathology, epidemiology, diagnosis, evaluation, treatment and prevention. The PGY-2 resident assists on many operative cases and master the clinical and technical skills necessary for proper pre- and postoperative treatment. Office diagnostic procedures including biopsy and colposcopy are performed under the supervision of the oncologist.
The PGY-4 resident assists the gynecologic oncologist in all surgical cases. This resident is expected to master the pre- and postoperative management of their patients while supervising the junior resident. The PGY-4 resident develops a thorough understanding of the diagnosis and treatment of gynecologic malignancies, and hones his or her surgical techniques while fulfilling the objectives of this service.
Finally, the PGY-2 and PGY-4 residents on the Gynecologic Oncology service present at Tumor Board each month alongside the pathology residents. Multiple gynecologic oncology cases are presented and reviewed with supervision by the gynecologic oncologists.
Reproductive Endocrinology and Infertility
The Division of Reproductive Endocrinology and Infertility is staffed by five full-time reproductive endocrinologists. The group has an office based invitro fertilization laboratory performing over 6,000 assisted reproductive procedures yearly. Through their rotation on this service, residents evaluate and manage patients with endocrinopathies and infertility while obtaining skills in ovulation assessment, semen analysis, obstetrics and gynecology ultrasound, endometrial assessment and hysterosalpingography. Residents learn the techniques of ovulation induction and assisted reproduction, including intrauterine insemination, in utero fertilization, pre-implantation genetic testing, third party reproduction, and fertility preservation for medical and elective reasons. Residents also perform operative hysteroscopy/laparoscopy, tubal surgery, adhesiolysis, and resection and ablation of endometrial implants.
Female Pelvic Medicine and Reconstructive Surgery
The Female Pelvic Medicine and Reconstructive Surgery division evaluates and treats urinary incontinence, pelvic organ prolapse, pelvic floor dysfunction, vaginal and urethral cysts, fistula repair, bladder inflammatory conditions such as interstitial cystitis, chronic pelvic pain and surgical complications.
Residents learn site-specific evaluation of patients with urinary incontinence, urinary retention and pelvic organ prolapse using POP-Q diagrams, simple and complex cystometrics, cystourethroscopy, uroflowmetry, pressure flow studies and voiding diary. Once the evaluation is complete, residents learn how to formulate a treatment plan utilizing various medical, surgical and non-surgical options that are available. Some of these treatments include pelvic floor exercises, pharmacological therapy, conservative management of pelvic organ prolapse with pessary, as well as minimally invasive and advanced surgical therapies.
Under supervision of senior fellowship-trained urogynecologists, residents perform vaginal, abdominal and laparoscopic/robotic pelvic reconstructive surgery, anterior and posterior colporrhaphy, abdominal and robotic sacrocolpopexy procedures, sacrospinous ligament fixation, uterosacral vaginal suspension, colpocleisis, vaginal slings for management of stress urinary incontinence, repair of perineal breakdown, fistula repair and enterocele repair.
Minimally Invasive Gynecologic Surgery / Robotic Surgery
Led by one of the pioneers in video-assisted laparoscopy and robotic surgery, Farr Nezhat, MD, residents are inspired to reach beyond their limits and are exposed to myriad aspects of the surgical management of malignant and benign gynecological conditions, and management of complications.
Through the use of NYU Winthrop’s training laboratories, residents and fellows have the opportunity to practice basic and advanced techniques of minimally invasive surgery under simulated conditions. Topics covered in the laparoscopic training lab include proper laparoscopic entry, a laparoscopic survey of pelvic and abdominal anatomy, laparoscopic and robotic instrumentations, tubal occlusion and salpingectomy, ovarian cystectomy, salpingo-oophorectomy, laparoscopic-assisted vaginal hysterectomy, total and subtotal hysterectomy, treatment of mild to extensive endometriosis, and closure of port sites. Residents are supervised closely in the operating room to apply skills learned in training laboratories. Advanced topics include different suturing techniques, dissection of the ureter, lysis of severe pelvic and bowel adhesions, pelvic and para-aortic lymph node dissection, and bowel and vascular injuries managements.
In addition to laparoscopic surgeries, residents are also actively involved in robotic cases on one of our three da Vinci surgical robots. Diagnostic and operative hysteroscopy for treatment of abnormalities such as removal of intrauterine fibroids, septum and adhesions, are also taught.
Residents are exposed to a variety of challenging pathological conditions which are referred to our division from other obstetricians and gynecologists, including gynecological malignancies, large uterine fibroids, severe pelvic and extragenital endometriosis, urogenital fistula, cesarean scar defect and ovarian remnant syndrome.
During the ultrasound rotation, the PGY-1 resident develops ultrasound skills at the Antepartum Testing Unit while receiving feedback from the MFM faculty and perinatal sonographers. The resident has the opportunity to perform cervical length and estimated fetal weight measurement, biophysical profiles and Doppler velocimetry of fetal and maternal vessels. Residents also participate in anatomy surveys, diagnostic fetal testing and other prenatal procedures. Residents attend weekly Perinatal conferences that provide a unique opportunity for learning and teaching. This rotation provides early opportunity for hands-on ultrasound training and allows development of skills that are utilized in daily patient assessment and care in all rotations during the residency.
Winthrop Women’s Wellness Center is an Article 28 clinic in Hempstead just a few miles from the Hospital. The clinic provides comprehensive prenatal care including education, social work and nutritional support as well as gynecological care. There are approximately 850 visits to the Center each month. This office serves as the residents’ continuity clinic, where they follow patients throughout their pregnancies and manage gynecological pathologies. Residents take ownership of their patients and actively participate in outpatient procedures such as colposcopy, endometrial biopsy and IUD or Nexplanon placements.
Surgical Intensive Care Unit (SICU)
PGY-1 residents become a part of the SICU team during this rotation. They evaluate and manage critical care patients and are involved in their multidisciplinary care along with pharmacists, respiratory therapists and critical care PAs under the supervision of the critical care attending physicians. They perform and assist in bedside procedures including central line and arterial line placement, paracentesis and thoracocentesis.
The night float team is comprised of four residents. Junior residents (PGY-1 and PGY-2) are responsible for the initial evaluation and management of patients presenting to the labor and delivery floor and to the emergency room for early obstetrical or gynecologic evaluation. The PGY-1 resident will be in charge of the postpartum pager, and the PGY-2 resident will hold the obstetrics and gynecology pager. The PGY-3 resident will primarily be responsible for the subspecialty MFM, obstetrics and gynecology oncology and uro-GYN patients. All residents are involved in the management of laboring patients, with the PGY-4 resident playing a supervisory role for all services. Obstetrics and gynecology cases are assigned at the discretion of the chief resident. Junior residents are primarily responsible for the uncomplicated vaginal deliveries and cesarean deliveries with the supervising chief present. The senior residents (PGY-3 and PGY-4) assume a lead role in more complicated gynecologic and obstetrical cases.
NYU Winthrop Hospital’s Breast Health Center provides comprehensive breast care through an experienced multidisciplinary team of medical oncologists, radiation oncologists, radiologists, pathologists and surgeons with extensive training and skill in breast, plastic and reconstructive care. PGY-4 residents have the opportunity to rotate with breast surgeons in the outpatient and inpatient setting. The rotation involves spending time in the office and assisting in OR cases. It is used as an opportunity to refine breast exam skills, interpret breast imaging studies and participate in the diagnosis and management of benign and malignant breast disease.
During the third year of training, residents have the opportunity to complete an elective rotation. Elective rotations may provide additional training in the subspecialty or other area of the resident’s interest in order to prepare for a future career path. Residents opt to pursue global health electives or pursue additional research opportunities during this time. Rotations may be conducted locally, out of state or even out of the country. The elective must be approved by the Program Director and the Graduate Medical Education office in order to ensure the elective rotation will be in congruence with ACGME guidelines. Salary and benefits from NYU Winthrop will be continued, including resident malpractice insurance. After the resident has received approval for the elective rotation from both departments, the resident is required to complete all necessary paperwork and clearance procedures before starting at the elective site during the five-week rotation.
Hospitalist Fellowship Program
NYU Winthrop Hospital established a unique one-year Obstetrics and Gynecology Hospitalist Fellowship program in 2013. This was the first program of its kind and to date, five Hospitalist Fellowship programs in the U.S. followed our lead in developing this subspecialty training program. The Department of Obstetrics and Gynecology at NYU Winthrop Hospital had already established a successful Obstetrics and Gynecology Hospitalist Program in 2011 under the directorship of Joseph Cioffi, MD. The program provides the fellow with the experience of managing daily obstetric and gynecologic conditions and emergencies, working closely with the residents and staff, and working as a safety officer for Labor & Delivery.
Minimally Invasive Fellowship Program
NYU Winthrop also offers a one-year or two-year fellowship in Minimally Invasive Robotic Surgery in Gynecologic Benign and Malignant Pathologies, under the directorship of Farr Nezhat, MD.
The fellow will work side by side with a multidisciplinary team of providers and will rotate at NYU Winthrop Hospital and New York-Presbyterian Hospitals (Weill Cornell Medical Center and Lower Manhattan Hospital). Several other faculty members, including those in urogynecology, general surgery and colorectal surgery will work closely with the fellow to provide complete patient care. The comprehensive program offers core training in gynecologic and minimally invasive surgery, including: advanced laparoscopic, robotic, hysteroscopic, abdominal, and vaginal surgery for complex, benign and malignant conditions; training in risk management such as minimizing adverse events and managing laparoscopic, robotic and hysteroscopic complications; participation in clinical research; development of teaching and leadership skills; and training in fiscal accountability.
Maternal Fetal Medicine Fellowship Program
The Maternal Fetal Medicine (MFM) Fellowship is an ACGME-approved combined program between Stony Brook University Hospital and NYU Winthrop Hospital. This three-year fellowship maximizes the joint experience between the two hospitals, where the fellows actively engage in fetal surgeries, diagnostic invasive procedures, ultrasound diagnosis and care of high-risk obstetric patients. A total of 16 months are devoted to mentored research with both clinical and basic science research opportunities. The 18 months of clinical training includes Inpatient, Labor & Delivery, Outpatient, Anesthesia, Sonography, ICU, Pathology and NICU rotations. Two months are dedicated to electives. Didactic conferences include a weekly Fetal Ultrasound conference, monthly Perinatal pathology and MFM-Neonatal Conferences, weekly research meetings, a weekly MFM Fellows lecture series, monthly journal clubs and biostatistics/epidemiology chapter reviews, as well as departmental Grand Rounds and Obstetrical Morbidity and Mortality conferences. Each graduate of the Maternal Fetal Medicine Fellowship program will have the expertise in clinical practice, research and public health, in addition to the skills needed to excel in the challenging environment of academic medicine.