Welcome to the website of the Obstetrics and Gynecology Residency Program at the University of California, San Francisco, Fresno. Our fully accredited academic program blends evidence-based clinical training, in-vivo and laboratory based simulation, research, and formal didactic educational experiences to prepare graduates for private practice, academic positions, or subspecialty fellowships.  Recent graduates of our program have been accepted to fellowships in advanced laparoscopic surgery(MIS), gynecologic oncology, gynecologic urology(Female Pelvic Medicine and Reconstructive Surgery), maternal and fetal medicine (MFM), and reproductive endocrinology (REI).  We are a regional campus and major teaching site of the University of California, San Francisco, School of Medicine, teaching 3rd year OB/GYN clerkships as well as 4th year elective students in general OB/GYN as well as maternal and fetal medicine.  Our faculty members hold appointments at the University of California, San Francisco, School of Medicine, and have received numerous awards for distinction in teaching.  The residency program is based at Community Regional Medical Center, a 628-bed regional academic medical center that serves a large and diverse patient population. Our hospital is the only tertiary care center in our region and operates the largest emergency room in California and the only level one trauma center between Los Angeles and Sacramento. More than 6,500 births occur annually at CRMC, and high risk OB patients are referred from fifteen hospitals in a region delivering 50,000 babies per year. Plans are underway to add another 100 beds to the medical center as well as to build an 800 bed replacement hospital with a Women and Children’s Tower. 


Outpatient Services
Residents provide outpatient care in our new clinic facility, The Deran Koligian Care Center, a 28,000 square foot building conveniently located on the Community Regional Medical Center campus.  In addition to specialty clinics, all residents attend a continuity clinic one half day per week throughout their residency. Residents rotate through a variety of OB/GYN clinics including oncology, colposcopy/dysplasia, REI, emergency room follow-up, drop-in, and FPMRS (female pelvic medicine and reconstructive surgery). We provide a variety of services in our clinic including well women / preventive care, prenatal visits, IUD placement, implantable contraception, office hysteroscopy and Essure placement, and pelvic floor diagnostic testing. Faculty members are always available in the clinic for consultation and assistance with patient care. High risk obstetrical outpatient experiences are gained in the University Women’s Specialty Center, a 5,000 square foot office immediately adjacent to the hospital providing comprehensive ultrasound services, antenatal testing, prenatal diagnosis and genetic counseling services, and perinatology consultation and continuing care. 


Primary Care - Obstetrics
The residency training program delivers approximately 2,800 infants a year, one third of which are high risk. In conjunction with our staff of mid-level practitioners, residents deliver a full range of low risk prenatal care services. Our L & D unit consists of 22 L/D/R (labor / delivery / recovery) rooms, 3 dedicated OR suites and a 10 bed triage unit. Both low and high risk patients are primary patients of the resident service and all management decisions and procedures are the responsibility of the residents with consultation and assistance from the general OB/GYN faculty and perinatologists. Faculty members are always present at board rounds and in-house faculty members are available for consultation and assistance 24 hours a day. 


 Primary Care - Gynecology
On the gynecologic service, residents become proficient in a comprehensive set of diagnostic and therapeutic procedures including laparotomy, vaginal, straight-stick laparoscopy, and robotic hysterectomy techniques. The hospital recently acquired a new 2-console DaVinci robot with simulator capabilities for resident education and we have implemented a formal 4 year robotic curriculum. The inpatient GYN service is led by two senor residents and the GYN attending for the month, who conducts regular teaching rounds as well as consulting on patient care.  We provide consultation services to a wide variety of providers including the Emergency Department, Pediatrics, Internal Medicine, and Family and Community Medicine.  In addition to the surgical experience from operating on our primary patients, senior residents receive extensive procedural experience with volunteer community faculty members during dedicated community surgery rotations, increasing the breadth and depth of surgical training as well as allowing residents to become familiar with the community physicians and their practices.

Gynecologic Oncology
The gynecologic oncology service provides consultation and surgical expertise for a large number of community physicians and practices in the region. Resident experiences include diagnostic procedures, GYN oncology surgeries, and end of life care. Residents operate one-on-one with the gynecological oncology faculty and provide surgical services at Community Regional Medical Center, St. Agnes Hospital, and Clovis Community Hospital, as well as staffing a busy outpatient gynecologic oncology clinic at the Deran Koligian Center. 

 

Female Pelvic Medicine and Reconstructive Surgery
Patients are referred to our pelvic floor medicine clinic from both our primary care practice and from private community physicians and receive a comprehensive urologic and pelvic floor evaluation.  Both medical and surgical treatment options are provided by our 3 pelvic floor faculty members.  Our residents receive one-on-one education in urodynamic studies and cystoscopy as well as in a variety of pelvic floor and incontinence surgical procedures and techniques. 

Reproductive Endocrinology and Infertility
Our REI clinic is staffed by Dr. Carlos Sueldo and his associates, a group that not only provides state-of-the-art clinical care but is also highly productive in research.  Residents provide REI care to the underserved in our outpatient facility during their 2nd year.  They then rotate in the 3rd year with Dr. Sueldo and Dr. Michael Synn, a former graduate of UCSF Fresno, OB/GYN, in the private practice office to gain more extensive experience in infertility care and in-vitro fertilization.  Residents assist Dr. Sueldo and Dr. Synn with both surgical and medical management of a diverse complement of patients and conditions.  In addition, residents have conducted numerous research studies through our collaboration with the Sueldo REI practice. 


Maternal and Fetal Medicine 
The Division of Maternal and Fetal Medicine is the largest perinatal practice in the San Joaquin Valley, accepting outpatient referrals and maternal transports from more than fifteen hospitals in the region.  Residents participate fully in the care of our high risk patients and receive hands-on training in cervical cerclage, external cephalic version, and amniocentesis and other high-risk procedures. Ultrasound training includes cervical length assessment, nuchal translucency, basic and targeted transabdominal, Doppler, 3-D, and fetal echocardiography under the direct supervision of the faculty perinatologists.  Our practice is accredited by the American institute of Ultrasound in Medicine in both obstetric ultrasound and fetal echocardiography and performs more than 500 non-stress tests and 2500 ultrasound procedures per month.  As a California approved prenatal diagnostic center, we receive a large volume of genetic screening and nuchal translucency referrals.   Consultations are provided in medical complications of pregnancy, preconception counseling, and diabetes in pregnancy, fetal medicine, isoimmunization, fetal and genetic abnormalities, and pregnancy complications. Our prenatal practice and hospital serve as the hub of a growing regional perinatology and transport program serving six counties with a combined delivery volume of approximately 50,000 deliveries per year.  Our residents rotate though the 84 bed NICU during their intern year to develop knowledge and skills that will assist in the management of our high risk OB patients. Our very large and diverse high risk obstetric population facilitates numerous ongoing research projects in preterm labor, diabetes, ultrasound, and other aspects of maternal and fetal medicine.  In addition, perinatology, neonatology, and genetics faculty collaborate with the residents on a monthly Perinatal Morbidity and Mortality Conference which covers a wide variety of topics including state-of-the art reviews of evidence-based care.