Mission

We provide high quality education and training for the progressive development of well-rounded women’s health care physicians in the context of the ACGME's six core competencies.

Vision

To be the premier Obstetrics and Gynecology Residency Program in the Defense Health Agency and produce excellent military clinicians and skilled consultants

Aims

• To graduate skilled obstetrician-gynecologists who are well prepared for independent practice.
• To develop competent leaders who will serve the military community and ensure military readiness.
• To train expert clinicians who are dedicated to scholarly inquiry and life-long learning.

There are many opportunities for formal didactic education. Morning report occurs every morning four days a week for 30 minutes and includes subspecialty lectures, case presentations, military unique curriculum, student presentations, and more. Thursday mornings are dedicated for resident education and includes preop conference, primary care lectures, simulation, Morbidity and Mortality (M&M) conference, grand rounds, etc. Separate Obstetrics and Gynecology M&M conferences occur quarterly, journal club and simulation occur monthly, and grand rounds occurs 2-3 times per year.

The main rotation structure is divided into four 13-week quarters. Most rotations cover half a quarter (6-7 weeks) while some rotations span the entire 13 weeks.

Residents received comprehensive training in the planned rotations as listed above; however, they are encouraged and supported to pursue elective rotations that will complement their individual goals and interests for training. An optional Planned Parenthood rotation is available during the PGY3 rotation for those residents desiring advanced family planning training. In the past, residents have participated in oncology elective rotations at Memorial Sloan Kettering and MD Anderson Cancer Center in Dallas, Texas.

The call schedule is created to ensure a senior resident (PGY3 or PGY4) and a junior resident (PGY1 and PGY2) are covering at all times. This translates into 2-3 call shifts a month. With the night float team covering Sunday – Thursday nights, the weekend call shifts include four 12-hour shifts from Friday night through Sunday day. Residents can choose to cover the full 24 hours on Saturday to increase the number of weekends fully off.

• Integrated into the academic curriculum schedule, residents are exposed to military unique topics that will serve them throughout their military career. At least once a month, morning report is dedicated to military unique curriculum where topics such as military medical career tracks, career management, deployment and operational assignments, department and clinic administration, and promotion expectations.
• Residents engage in learning aspects of obstetrics & gynecology unique to the military such as menstrual management and contraception for the operational soldier, delivery of medical treatments in an austere environment, and management of pregnancy-related issues in deployed settings.

• Basic Life Support
• Advanced Life Support
• Intermediate Fetal Heart Rate Monitoring
• Advanced Life Support for Obstetrics (ALSO)
• Emergencies in Clinical Obstetrics (ECO)
• Neonatal Resuscitation Program (NRP)
• Fundamentals of Laparoscopic Skills or Essentials in Minimally Invasive Gynecology
• ASCCP Comprehensive Colposcopy Course

• Resident training at Madigan is strengthened by a robust simulation curriculum. For the first Thursday of every month, resident didactics is dedicated to simulation training. Some of the exercises that are simulated include postpartum hemorrhage drills, operative deliveries, manual vacuum aspiration with papaya model, delivering bad news, deposition training, and many others.
• We participate in multidisciplinary simulation exercises quarterly with surgical services and with Labor & Delivery staff.
• Residents have access to the Andersen Simulation Center which is a premier site for providing medical simulation support to numerous training programs across Joint Base Lewis-McChord. The Andersen Simulation Center is an active member of the American College of Obstetrics and Gynecology’s Simulation Consortium.

Residents are encouraged to participate in many available leadership opportunities with the organization to include membership of hospital committees, representative to the Residency council, and participation on other GME committees. They also participate in ACGME workshops focused on leadership and professionalism. Residents are encouraged to seek out leadership positions in national organizations such as American College of Obstetrics & Gynecology.

In line with ACGME requirements to participate in scholarly activity, residents must complete one research project during residency. Completion of a research project is defined as a manuscript formatted for submission to a peer-reviewed journal if the scholarly activity is related to research. There are many opportunities to perform and present research during residency training. While there is not a specific research rotation, several rotations have scheduled time dedicated to completing research projects. Locally, residents have the opportunity to present research at the annual department research update and Madigan Research Day. Residents commonly present research at ACOG Armed Forces District meeting every year. There are encouraged and supported to submit and present at other national conferences such as ACOG Annual Clinical Meeting, the Society of Maternal Fetal Medicine Annual Meeting, the American Society of Reproductive Medicine Annual Meeting, and others. Residents receive funding for up to two conferences a year to present research.

Residents are required to participate in or perform at least one quality improvement or process improvement project during residency. They routinely serve on root cause analysis inquiries and other risk management committees within the hospital. Residents complete a series of four ACGME workshops, two of which focus on patient safety and quality/process improvement.

Residents are exposed to the importance of continued professional development throughout a career as an obstetrician/gynecologist. This includes a consistent emphasis on life-long learning, incorporation of evidence-based practices, and a focus on scholarly activity and inquiry. Residents are often called upon to lead multidisciplinary teams focused on providing quality patient care with emphasis on patient safety and patient-centered outcomes. They have access to professional development courses and activities sponsored by the Faculty Development fellowship. Aspects of academics and medical knowledge assessments mimic the format for oral board examinations setting them up for successful board passage to obtain board certification. Senior residents are supported to attend the Armed Forces District Meeting of ACOG to network with military leaders as they are making decisions on their first duty stations and beyond.

• Madigan Army Medical Center
• Multi-care – Tacoma, Washington (Tacoma General Hospital, Allenmore Hospital, Good Samaritan Hospital) – oncology and benign gynecology rotations during PGY3
• Virginia Mason Franciscan Health – Tacoma, Washington (St. Joseph Medical Center, St. Clare’s Hospital) – Labor & Delivery rotation as PGY2
• Naval Hospital Bremerton – Benign gynecologic surgeries during benign gynecology rotations
• Planned Parenthood – optional family planning opportunity in Tacoma and Olympia

Prospective residency applicants can rotate on site during the 3rd and 4th year of medical school for a sub-internship (audition) rotation. A full 4-week rotation is divided into two blocks consisting of an obstetric assignment (L&D or nights) and a subspecialty assignment (MFM, REI, Urogyn, Gyn Onc, or benign GYN). Each student will be paired with a resident and faculty who will serve as mentors to address any questions and facilitate a productive sub-internship. Abbreviated rotations are available per request to accommodate scheduling conflicts while still allowing for onsite exposure.

For applicants rotating for an audition rotation, interviews are conducted toward the end of the block and consist of four 30 minute interviews (program director, associate program director/faculty, midwife, and resident). Applicants are requested to provide their CV, professional photo, and a personal statement and should dress in Class A Army Service Uniform (either blue or green). Applicants are given the opportunity to ask the interviewers any questions they may have regarding the program. Applicants who are unable to participate in a full 4-week rotation are encouraged to arrange for an in-person interview or virtual interview.

A majority of graduating residents will seek board certification through the American Board of Obstetrics and Gynecology. Residents who hold a Doctor of Osteopathy degree are eligible to seek board certification through the American Osteopathic Board of Obstetrics and Gynecology. Although the timing and components of the process are slightly different, both boards require passage of a written qualifying exam followed by an oral certifying exam. Further information can be obtained from the respective board websites: American Board of Obstetrics and Gynecology and American Osteopathic Board of Obstetrics and Gynecology.

Residents are constantly engaged in teaching opportunities as Madigan is a core clerkship site for Uniform Services University and a partner with University of Washington School of Medicine. Residents universally take advantage of the opportunity to become faculty at USUHS leading them to take a primary role in the education of medical students. Chief residents are responsible for leading problem-based learning modules for obstetrics and gynecology topics for the rotating medical students.

Residents are primarily responsible for many aspects of didactic education leading morning report, preoperative conferences, and journal clubs. They often have the opportunity to teach residents from other programs such as Family Medicine and Transitional Year who rotate through the OB/GYN department. There are also opportunities to teach at academics for Family Medicine, Internal Medicine and Emergency Medicine as well as participate as presenters at hospital wide conferences such as the annual Contraceptive Conference.

The following subspecialties are represented by fellowship-trained faculty:

• Urogynecology and Reconstructive Pelvic Surgery
• Gynecologic Oncology
• Reproductive Endocrinology and Infertility
• Maternal-Fetal Medicine

The faculty are actively engaged in mentor relationships with the residents providing individual and group mentorship through research projects, surgical skills training, journal club activities, and others. During the first two years, residents receive direct mentorship from a Certified Nurse Midwife in the management of a Centering Pregnancy group. By the middle of the intern year, residents are encouraged to formally identify a faculty to serve as their primary mentor. While the program director provides resources and information to guide the mentor/mentee relationship, the degree to which residents interact with their mentor is driven by the resident’s goals and interests.

Resident wellness is a central motivating factor to the program to facilitate a learning environment conducive to developing well-rounded OB/GYN physicians and military officers. There are several opportunities for the resident team to participate in activities as an entire group while staff cover all clinical activities. This includes a weekend fall retreat where residents organize a getaway to build comradery, discuss residency issues, and plan yearly activities. They are also given the day following CREOG exam to participate in winter training which has consisted of a ski trip to Crystal Mountain, as well as protected time to attend and participate in the end of year graduation banquet. There are department events to include a summer picnic to welcome the new interns, a holiday party, and numerous potlucks to celebrate special events.

Numerous fitness-oriented activities are available to include Run Club, Lift Club, and the Army Confidence Course. Residents participate in formal wellness education through GME sponsored ACGME workshops and monthly resiliency exercises led by department behavioral health psychologists. There are also many spontaneous social gatherings that promote a family atmosphere that is a hallmark of the Madigan OB/GYN residency program. These include trivia nights at local breweries, evening journal club at staff homes, game nights, escape room, and many others.