Obstetrics and Gynecology

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Warm greetings from the Grand Rapids Medical Education Partners Obstetrics and Gynecology Residency Program. Our residency program brings the resources of two campuses which includes Spectrum Health Butterworth and Mercy Health Saint Mary's.

We have 32 residents, eight at each level. Our residents rotate through both of the above hospitals, which are in close proximity to each other. Each hospital has somewhat different patient populations and attending staffs, giving our residents a very broad experience in education and patient care. We have thirteen sub-specialists on our combined faculty. The residents receive in-depth training in Maternal Fetal Medicine, Reproductive Endocrinology, UroGynecology and Gynecologic Oncology. Extensive teaching of operative laparoscopy, and ultrasonography are additional strong components of our program.

We are affiliated with the Michigan State University-College of Human Medicine. Our residents receive appointments as Clinical Instructors from that institution, and have the opportunity to teach third and fourth year medical students who rotate through the hospitals. Our residents also participate in the training of Family Medicine, Emergency Medicine and Transitional Year residents.
The patient volume at each hospital is very high. Our resident's procedure experience ranks near the top nationally. However, we still stress education above service, and we have protected time for resident's participation in didactic conferences. Residents are given an ample allowance to attend conferences at away locations after their first year. We have maintained flexibility in the development of our program and have actively involved residents during the construction of the curriculum. We have a "night float" call system at Mercy Health Saint Mary's and at Spectrum Health Butterworth Campus.

Western Michigan has four extraordinary seasons making Grand Rapids a wonderful place to live year around. The excellent schools, the many cultural events, and the abundance of outdoor activities make Grand Rapids an excellent community for raising a family.

We welcome your inquiries, and look forward to seeing you.

Michael S. Werkema, MD
Program Director

 Click here for information about our resident benefits package.

More about our Program

The exciting opportunity, which exists for current and future residents, is the chance to contribute to the creation of a dynamic residency program. You will be entering a program which contains not only an incredible wealth of excellent board-certified volunteer faculty, but also some of the best fellowship trained sub-specialists which include five in Maternal Fetal Medicine, three in Reproductive Endocrinology, two in Gynecologic Oncology and one UroGynecologist.

As you progress through your training, experience is provided in the following:

Obstetrics and Gynecology (a required total of 18 months in each area)
- Includes supervising laboring patients, teaching first year residents as well as medical students, gaining experience in advanced surgical skills, gynecologic pathology, colposcopy,  laser and robotic surgery.
-Managing your own patients in our continuity care clinic for four years

 

Additional areas of focus include:

•    research (completion of a scholarly project - required)
•    urogynecology
•    ultrasound
•    breast disease
•    surgical training courses (surgical skills labs) and simulation labs

You will function as an administrative chief resident in your 4th year. Responsibilities include assigning gynecologic surgical cases to other residents and acting as surgeon on all clinic cases and some private cases which have been assigned to you.
Our residents have always had the opportunity to improve the quality of their education through feedback and suggestion – this will never change. Neither will the excellence towards education from dedicated teaching staff.

 

OB/GYN Divisions

Obstetrics

Between the two hospitals, over 10,000 obstetric deliveries take place annually (Butterworth 7500+, Saint Mary's 2500+). Approximately 15-20% of these obstetric deliveries are traditional "clinic" patients whose care is provided by the resident under the supervision of a faculty member. The other obstetric patients are private patients of obstetricians throughout the city. The patient population includes normal obstetric patients and high-risk patients referred to sub-specialists in maternal-fetal medicine. Our resident clinic is the largest in the state, with our residents delivering approximately 1600 patients per year.
A full range of high-risk problems is seen routinely during the four years of residency. Common high-risk problems include:

•    Multiple gestations
•    Metabolic disorders
•    Toxemia of pregnancy
•    Hemoglobinopathies
•    Substance abuse

 

Maternal Fetal Medicine - High-Risk Obstetrics

Our faculty has seven board certified sub-specialists in maternal medicine. The residents will spend one rotation in R1, R2, R3 on the high-risk obstetric service, at the Spectrum Butterworth campus. Dr. Zuidema, Dr. Fee, Dr. Day and Dr. Sheikh staff this service. Dr. Jelsema, Dr. Balaskas and Dr. Cummiskey are additional maternal fetal medicine sub-specialists at the Butterworth and Mercy Health Saint Mary's campuses. The Regional Neonatal Intensive Care Unit is located at Spectrum Butterworth, and this generates a large volume of transferred high-risk patients from all over western Michigan. In the first year the resident will be on this service for 4 weeks as well as 6 weeks in the second and third years.
While on the perinatal service, the residents manage high-risk patients on the antepartum ward, in labor and delivery, the post partum ward, and in the intensive care unit. They also learn the techniques of ultrasonography and genetic amniocentesis. They participate in genetics counseling and assist with CVS and PUBS procedures.

Mercy Health Saint Mary's also has a level III special care nursery that is staffed by board certified neonatologists. Therefore, our residents are exposed to an ample volume of complicated obstetric patients.

Spectrum Health Butterworth has two High Risk Clinics per week. The care of the high risk patient at Mercy Health Saint Mary's is incorporated into the continuity clinic. There is an educational and working conference that is associated with each clinic session. The perinatologists supervise these clinics, and conferences.
Throughout the four years, the residents also attend a variety of didactic teaching conferences. Obstetric statistics and complications are presented at each hospital on a monthly basis. There is a multi-specialty fetal anomaly conference once a month and perinatologists give lectures every month. Weekly neonatal rounds take place at the Spectrum Butterworth campus.

 

Genetics

Genetics is primarily learned during the rotations on perinatology in the first year. While on these rotations, the residents participate in genetic counseling and diagnostic procedures. While on the Spectrum Health Butterworth Campus rotation, the residents work closely with a genetics counselor. Residents are also able to perform genetic amniocenteses and develop their skills with obstetric ultrasound.
Residents develop their skills with prenatal genetic testing and counseling in their own continuity clinics. When the patient requires consultation with a perinatologist, the resident is able to follow their patient and stay involved in the evaluation process.

There is a monthly Fetal Board that is multi-disciplined and includes participants from the genetics department. Didactic lectures are also presented to the residents on genetic topics.

 

Fetal anomalies

Although many patients come from private attendings, residents participate actively in the management and therapeutic decisions of all complicated obstetric patients.

As a resident in Obstetrics/Gynecology, you will gain experience in normal obstetrics in each of the four years. The first and second years receive the greatest exposure to obstetrics. In the first year, the resident spends 5 months covering labor and delivery. The second year residents similarly cover labor and delivery for 18 weeks during the day, but they also cover labor and delivery for 12 weeks in a "night float" system. In the third year, residents spend 6 weeks on obstetrics. In the forth year, each resident spends 6 weeks as the chief of obstetrics.

Supervision is provided, in house, twenty-four hours a day by either our core faculty or attending faculty.

Starting in the first year, each resident has obstetric patients included in their own personal continuity clinic. In this clinic setting, they provide prenatal care under the supervision of upper level residents and an attending physician.

All residents are expected to attend "morning report" for either Obstetrics or Gynecology each day wherever assigned. At this conference, the management of labor and delivery patients or gynecology patients are reviewed with the chief resident as well as an attending and treatment plans are generated.

During the obstetrics rotation, residents learn the mechanics of spontaneous and operative delivery under the supervision of more senior residents and the attending faculty. They learn how to use forceps, the vacuum extractor, and how to perform cesarean sections. They are also responsible for post partum care and the management of complications. Vaginal delivery after cesarean section is encouraged, and residents have a sound experience in managing and delivering these patients. Residents learn the technique of external cephalic version of a breech presentation. Vaginal breech deliveries are allowed in appropriate patients, and the residents are actively involved.

Topics in normal obstetrics are also presented in didactic lectures, grand rounds, obstetrical statistics conferences, and at morning report.

 

Ultrasonography

Formal instruction in ultrasound techniques is obtained in several different areas. In the second year, the residents learn how to perform vaginal probe ultrasound from one of three reproductive endocrinologists, Dr. Dodds, Dr. Leach and Dr. Young. The first year resident also spends a month on the maternal fetal medicine service at Spectrum Butterworth and they are trained in obstetrical ultrasound by the perinatologists. In the second and third year, the residents spend another six weeks on maternal fetal medicine where they get additional training in ultrasound. Dr. Edvenson, a private physician, has first year residents come into his private office where he teaches both obstetric and gynecologic ultrasound techniques.

Each labor and delivery unit has a portable ultrasound unit that is provided for resident use on a continuous basis. Residents perform their own scans on laboring and prenatal patients as needed. Upper level residents and the attending faculty supervise the lower level residents, as their skills develop. Residents average approximately 150 vaginal probe ultrasounds with a much higher number of abdominal scans during their four years of training.

 

Operative Gynecology

The experience in operative gynecology is gained at each hospital during the entire residency. It increases incrementally as the resident progresses through the four years. Even in the first year, the resident is assigned to a formal rotation on the gynecologic service, assisting in cases such as: endometrial ablations, hysteroscopy, laparoscopic tubal ligations, and dilation and curettages.

In the second year, each resident spends 6 weeks on the gynecology service. During this time, they learn to do routine pre- and post-operative care. They also learn more advanced procedures, such as operative hysteroscopies, laparoscopies, LASER ablations, and sterilizations. Also during this year, they assist on major operative procedures.

During the third year, the resident concentrates primarily on gynecology, spending 18 weeks on the gynecology service, 6 weeks on reproductive endocrinology and 6 weeks on gynecologic oncology. During this year, the residents become involved in complicated pre- and post-operative care, performing abdominal and vaginal hysterectomies, exploratory laparotomies, operative hysteroscopies and laparoscopies, and pelvic prolapse repairs. The reproductive technologies, including GIFT, ZIFT, IVF, micro-surgical techniques and the use of LASER modalities are taught. The resident is usually the operating surgeon and the attending faculty assists them. To help our residents develop microsurgical techniques and to become more adept at delicate surgery, we utilize a small animal laboratory. In addition, we have an animal laboratory that enables us to teach our residents the principles of surgery on the bladder, bowel, ureter, and vascular structures. Another "dry lab" is used to teach endoscopic and electrosurgical skills on inanimate models.

In the last year, each chief resident receives surgical experience from the gynecologic service as well as administrative duties to assign surgical cases. They receive further surgical experience during the gynecologic oncology service and urogynecology. They assume responsibility for all aspects of operative gynecology, as well as becoming involved in teaching other residents. The level of supervision is commensurate with the level of expertise the resident has developed to that point.

 

 

Reproductive Endocrinology and Infertility

The resident’s experience is the responsibility of  Dr. William Dodds, Dr. Richard Leach, and Dr. James Young. In the third year, the resident spends six weeks on the reproductive endocrinology service. While on this rotation, the resident becomes actively involved in the evaluation and management of infertility patients. They become skilled at managing clomiphene citrate therapy, and they learn the principles of gonadotropin stimulation. They also learn about the more advanced technologies and participate in the GIFT, ZIFT, and IVF procedures.

The sub-specialists give reproductive endocrinology and infertility lectures monthly.

The residents learn microsurgical skills from the sub-specialists and while operating with Dr. Douglas VanDrie. They also develop their microsurgical skills in the small animal laboratory that is supervised by Dr. Werkema.

 

Urogynecology

Residents spend four weeks on Urogynecology in their first year with Dr. Douglas VanDrie. Additionally, residents spend six weeks on a Urogynecology rotation in both their third and fourth year. During the first and fourth year, residents rotate with Dr. Douglas VanDrie, a gynecologist with a special interest in urogynecology. During the third year, residents rotate with Dr. Christine Heisler, a fellowship trained board certified UroGynecologist. On both of these rotations, the residents learn how to complete a full urodynamic work-up and to evaluate the structures that support the pelvic floor. They also participate in a variety of pelvic floor surgical procedures.

Special clinics for urogynecology are also in place at Spectrum Health Butterworth campus. Fourth year residents participate in the clinic under the supervision of Drs. VanDrie and Heisler. Didactic lectures are also given by attending physicians specializing in the field.

In addition, other members of the attending staff also perform surgical procedures for incontinence and pelvic prolapse giving the residents a very good experience doing these cases during their third and fourth years.

 

Gynecologic Oncology

Our residents encounter patients with gynecologic malignancies on the general gynecologic in-patient services and the gynecologic oncology service. This exposure occurs primarily in the third and fourth years. The service is basically the private practice of Dr. Gordon Downey and Dr. Charles Harrison at Spectrum Health. In the second year, residents spend three weeks with Dr. Kevin Brader at Mercy Health Saint Mary's. All are board certified gynecologic oncologists.

During these rotations, the residents participate in the care of all patients admitted onto the service. A large volume of radical surgery is done on this service and the residents have a very good experience participating in these cases. They also see patients in the private office, and follow these patients to surgery or other therapies. In this setting, the residents participate in overseeing chemotherapy. Throughout their training, the residents also attend numerous oncology and pathology conferences. At these conferences, the management of the oncology patients is discussed and the principles of radical surgery, chemotherapy, irradiation therapy, and brachytherapy are reviewed.