Advocacy

Saint Joe’s is committed to advocacy work on a local and national level. Each year our residents are relieved of clinical duties to attend the Colorado State Lobby Day at the Colorado State Capitol, a few blocks away from the hospital, where we meet with local representatives to advocate for state-wide legislature to better women’s health. In past years, we have lobbied for extending FMLA coverage for better maternity leave options, and improved contraceptive coverage.

Our residents work closely with ACOG Colorado, who each year generously sponsor residents from both St Joe’s and CU to attend the national ACOG Congressional Leadership Conference. This conference is an excellent opportunity to learn the basics of advocacy, how-to lobby sessions, and ultimately meet our state senators and representatives to lobby for national bills affecting women’s health. In past years, we have lobbied for and helped pass legislation to establish funding for Maternal Mortality Review Committees in all 50 states to address our nations increasing maternal mortality rate, to extend Medicaid coverage for pregnancy through one year postpartum, and to increase NIH funding for research into women’s health diseases.

Rotation Schedule

The overall educational objectives of the Obstetrics and Gynecology Residency Program at Saint Joseph Hospital are based on Educational Objectives: Core Curriculum in Obstetrics and Gynecology as published by the Council on Resident Education in Obstetrics and Gynecology. This format is reviewed with each new edition, and continues to allow for the training of physicians in the primary and preventive care of women, pregnancy, and the female reproductive system.

We expect our physicians to be able to evaluate the general health care needs of women, and deviations from normal in women, so that they can appropriately refer to other specialists. We strive for compliance with all aspects of the RRC Requirements.

All patients admitted to the service are considered "teaching patients," and house staff members participate in their complete management and care. House staff participation in the care of patients is consistent with the demonstrated experience, ability and comprehension of the resident. Progressive responsibility is the expected norm with culmination in the chief year.

The hospital provides an in-house clinic, Seton Women’s Center, for patients without insurance or other means of full payment, and local county clinics regularly refer patients to Saint Joseph Hospital for care. This enables the residents to have both obstetrical and gynecologic continuity clinics throughout their four years of training. Residents follow their own patients and are involved in their patients’ deliveries and gynecologic procedures. There is faculty supervision in the clinic at all times and in-house coverage 24 hours a day. There is a large Hispanic population among our uninsured patients. Proficiency in Spanish is definitely an asset, but not a requirement.

Residents are trained in counseling patients in all aspects of family planning and our practice respects the Ethical and Religious Directives for the Catholic Health Care Services (ERDs). To meet the RRC guidelines on the Family Planning curriculum, teaching and simulations pertaining to family planning are done in the hospital and clinic. Those procedures and surgeries that are not available at Saint Joseph Hospital are done at outside clinics (funded by the Ryan program) and other hospitals with either private attendings or our own faculty. 

Our blocks are 5 weeks in length, and we have 10 blocks in a year. There are 2 weeks around the holidays where we cross-cover to allow for added time off, which is a nice bonus for our residents to be able to travel for the holidays.

PGY-1

First-year residents can count on a full obstetrical experience, including a rotation on the high-risk Antepartum service. They spend 2 rotations on OB Days and 2 rotations on OB Nights, and many residents meet their vaginal delivery numbers in their first year alone. Saint Joseph Hospital is home to one of the busiest Labor & Delivery units in Colorado where we average more than 4,000 deliveries yearly.

First years spend one rotation on a “Postpartum/Clinic” rotation. They spend mornings postpartum rounding with the attendings and gain invaluable knowledge regarding the normal postpartum course as well as common postpartum problems. Afternoons are spent in our resident clinic where they gain ambulatory knowledge and skills.

One block has been dedicated to addressing clinical applications of ultrasound where our residents become proficient in both independently performing and interpreting OB and GYN ultrasounds.

Interns also spend two rotations on our busy GYN service and begin honing their surgical skills in minor procedures such as D&C’s, hysteroscopies and basic laparoscopy. They also get practice holding the pager and seeing consults in the emergency department for GYN-related problems. The GYN rotation also provides an opportunity for Family Planning experiences.

PGY-2

Second year residents enjoy increasing responsibility in obstetrics and spend 20 weeks leading the L&D team as the Deck Doc while managing high-risk obstetric patients and honing their surgical skills performing the majority of c-section deliveries and becoming proficient in operative vaginal delivery technique.

Second year residents work closely with MFM attendings in both inpatient and outpatient settings with exposure to a variety of complex obstetrical cases given Saint Joseph Hospital is home to a recently expanded 51 bed, level 3 NICU that cares for babies born as early as 22 weeks.

There is also a dedicated elective block for residents to gain exposure to family planning services and pursue research opportunities.

PGY-3

Third year residents step into a new leadership role while serving as OB chief and act as a consulting provider for a busy certified nurse midwifery hospital-based practice. Third years (as well as fourth year residents) also participate in the obstetrics night float system and as the "Clinic Chief,” where they serve a vital role in teaching lower level residents and medical students.

Residents build on their strong foundation of GYN surgical skills while covering GYN cases at several high-volume Denver metro ambulatory surgical centers. Third year residents have exceptional exposure to minimally invasive surgical techniques including a robust robotic surgery practice. Residents rotate through a busy urogynecology service where invaluable vaginal surgical skills are gained. Residents also enjoy an “Elective” rotation in their third year. This provides an opportunity for those pursuing fellowship to go on away rotations or participate in additional research.

PGY-4

Fourth year residents share the responsibilities of "OB Chief", "Clinic Chief", "GYN Chief", and "GYN Oncology Chief" overseeing their entire respective services. Fourth year residents serve as leaders of the residency and each year two administrative chiefs are elected who oversee scheduling and serve as dedicated mentors to lower level residents as they transition to new roles within the program. The other 3 fourth years gain the titles of “Wellness Chief,” “QI Chief,” and “Education Chief.”

During the final year of residency there is a focus on advanced surgical technique and fourth year residents perform complex open GYN cases, as well as 10 weeks dedicated to minimally invasive gynecology surgery. Our residents graduate with proficiency and high volume training in laparoscopic, vaginal, and abdominal hysterectomies.

They also have an elective rotation where they can pursue additional areas of academic interest, either locally or abroad. One fourth year per class can choose to join the Global Health elective rotation in Tanzania.

Didactics

At Saint Joe’s, we prioritize teaching. Each morning a resident or faculty member leads a half hour lecture in GYN or OB prior to the start of the work day. These lectures are protected education time for all residents. This is an opportunity to review an ACOG practice bulletin, go over new guidelines, spend extra time in the simulation lab, or review common procedures. We also use this time at least once per block for a resident-only meeting to address any issues that arise in an effort to continually improve the resident experience. We especially enjoy having this protected time to come together and have breakfast with our fellow residents before we start our busy days.

On Friday afternoons, we have 3 hours of protected lectures from 1 to 4 p.m. During this time, the faculty hold all pagers and cover all services. This time is usually divided into 3 lectures from faculty, specialists, or guest speakers. We cover a broad range of topics, from bread and butter OB-Gyn, to time in the simulation lab to train our surgical skills as a group, to resident-developed curricula on global health, implicit bias, and health equity/anti-racism. Once a rotation, the chief of both Obstetrics and Gynecology prepares a Morbidity and Mortality conference in preparation for oral boards. Residents also review scholarly articles in our “Journal Club” and present upcoming cases and surgical indications in our “Preop Conference” every block. We love having this time to learn and unwind together at the end of the week.

Global Health

Saint Joe’s has developed a global health curriculum to educate our residents on topics surrounding global health, to promote awareness among the residents of global disparities in health outcomes, and to support women’s health around the world, both in low- and middle- income countries and in our underserved populations at home. This curriculum is in the form of quarterly lectures during our scheduled didactics given by both faculty and residents. The potential benefits of having a structured global health curriculum include:

  • Greater understanding of disparities, cultural differences, and socioeconomic factors affecting healthcare in Colorado's patient population.
  • Stronger preventative medicine/public health awareness
  • Increased awareness of the importance of patient education
  • Better utilization of physical exam and history taking skills
  • Understanding of political influences over healthcare
  • Better understanding of cost-utilization in medicine.

In addition to this curriculum, we have an established relationship with Arusha Lutheran Medical Center in Arusha, Tanzania that accepts one chief resident each year to travel with a faculty attending during their elective block. During this elective, the St. Joe’s team provides workshops for local practitioners to develop laparoscopic and vaginal surgical skills, and participates in outreach clinics for cervical cancer (VIA) and HIV screening in remote Maasai villages.

Our residents have also pursued other global health opportunities.

Health Equity, Diversity, and Inclusion

Our Seton Women’s Center primarily serves patients and communities that have been socially and economically marginalized, and our efforts toward achieving health equity are an integral part of the SJH OB-Gyn residency program. We strive to continuously work towards achieving a more diverse and equitable environment in the following ways:

  • Residency Climate and Retention: We are committed to maintaining an inclusive and supportive culture and an environment free from harassment and discrimination. Residents and faculty participate in education around topics such as upstander training, implicit bias, and microaggressions as part of our regular curriculum. We also offer community-building events and access to group and individual mentoring opportunities in order to increase support for BIPOC-identifying physicians.
  • Recruitment: We recognize that a key part of addressing health inequities is recruiting and retaining a diverse physician workforce. We also have preference for candidates with a demonstrated high commitment to the care of marginalized populations, strong connections to disinvested communities, advocacy and leadership experience, and Spanish language proficiency.
  • Health Justice Curriculum: We are committed to teaching toward health justice as a part of the core curriculum of our residency program. This curriculum works to teach physicians to deeply understand the structural factors at play in issues of health as well as to develop strategies to counter them. Along with the implicit bias and other training mentioned above, this longitudinal curriculum also includes learning around health/healthcare inequities, racism and other structural barriers to health/healthcare, resource allocation, social determinants of health, and LGBTQ+-specific training. We specifically work to equip learners with knowledge, frameworks, and tools to apply while creating interventions at micro-, meso-, and macro- levels of health systems.
  • Community and Advocacy: We are committed to providing high level care to our historically marginalized patient population and working to eliminate the inherent barriers and bias that contribute to inequities in health outcomes. We commit to exploring the partnerships available to us in our community to work towards achieving health justice. We will train and offer opportunities to our physicians for leadership, advocacy, research/QI, and organizing work in health justice.

Scholarly Activity

We work hard at St. Joe's to create a culture of evidence-based medicine and inquiry. Our residents are required to participate in a variety of scholarly activities during their training at St. Joe's. These activities include:

  • Presentation and participation in journal club
  • Presentation and participation in Morbidity and Mortality conferences
  • Participation in an annual residency-wide quality improvement initiative
  • Development and completion of a scholarly project which may include everything from basic science research to publishing review articles on important topics within the specialty
  • Presentation on scholarly projects at an annual Residency Research Day
  • Support to travel to national meetings to present scholarly projects
  • We want our residents to develop scholarly projects that are important to them - and relevant to their planned career path! We are fortunate to have the mentorship and resources available to support our residents to reach their goals.