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Reproductive Endocrinology & Fertility

Educational Objectives:

The mission of the Reproductive Endocrinology/infertility service at Tulane/Lakeside Hospital (TLH), and University Hospital (UH) are intended to provide the following objectives for Resident education:

  1. A comprehensive experience in the anatomy, embryology, genetics, endocrinology, pathology, and physiology of reproduction.
  2. A comprehensive experience in the diagnosis and management of reproductive dysfunction (Infertility) or reproductive control (contraception).
  3. A comprehensive experience in the diagnosis and management of common endocrinopathies experienced in a gynecological practice.
  4. Experience in hormonal and surgical management of menstrual disorders.
  5. A comprehensive experience in the diagnosis and management of the symptoms and sequalae of the menopause (including osteoporosis).
  6. Hands-on experience with microsurgical, operative laparoscopic and hysteroscopic procedures.
  7. Hands-on experience with pelvic ultrasound.
  8. Exposure to Medical Informatics and Internet-based learning.
  9. Observation of Assisted Reproductive Technology (ART) procedures.

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Exposure to these educational opportunities is accomplished through several venues which are based at either the Tulane/Lakeside Hospital (TLH) or University (UH). The instructional model consists of cognitive and psychomotor components, which are delivered to the resident depending on his/her level of training.

Endocrine conferences are held on the third Friday of each month. Each month, a didactic endocrine topic is covered in lecture format. Topics are chosen from the core Educational Objectives for Resident Education in Obstetrics and Gynecology (see Conference Schedule).

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3rd and 4th year Resident Responsibilities

Endocrine Clinic

University Fertility Clinic: Thursday PM

Patients with infertility, endometriosis, menstrual disorders, endocrinopathies, and menopausal complaints are scheduled by referral to the REI clinic at the University Hospital, New Orleans, LA. The clinic is conducted with Dr Clisham. It is the responsibility of the senior Resident to review all records of patients scheduled in this clinic prior to clinic start to discuss management plans with staff. The Endocrine Resident is also responsible for ensuring adequate Resident presence from the Tulane service to provide care for patients scheduled in a timely fashion. The Endocrine Resident must review all patient records and obtain all laboratory results from preceding visits to expedite the flow of the clinic. Surgical endocrine cases are reviewed by the Endocrine Resident for appropriateness prior to presentation to staff and scheduling. Cases are scheduled with faculty on a case by case basis. OR cases may be scheduled for the second Thursday AM of each month at University Hospital. Cases will be staffed by Dr Clisham.

Faculty Fertility Clinic: Tulane/Lakeside - Monday, Tuesday, Wednesday AM, Wednesday PM

The Endocrine Resident is expected to attend all scheduled office hours. S/he is expected to actively participate in the evaluation and management decisions of patients scheduled. This office experience provides the Resident with an overview of outpatient management of endocrine, menopause, gynecologic and infertility problems in a private-pay setting. It allows first-hand experience with the current health care systems reimbursement issues as they relate to a multitude of differing diagnosis. Direct experience with transvaginal probe ultrasound is provided. Residents are exposed to the performance and interpretation of a number of procedures such as the hysterosalpingogram, hysterosonography, post coital test, timed endometrial biopsy, semen analysis, etc. Additionally, Residents are exposed to ovulation induction.


UH Service: (2nd Thursday AM of each month)

It is the responsibility of the Endocrine Resident to ensure that patients scheduled for surgery have appropriate pre-operative counseling and evaluation. The Resident must confirm that patients scheduled for surgery have been registered with Admissions and booked in the Operating Room for the appropriate date and time. The history and physical, laboratory values, and imaging studies should be reviewed by the Resident with the Attending Physician prior to Thursday afternoon, before the scheduled Friday case. All specialty equipment needed for operative cases (operating microscope, laser, micro-surgical instruments) must be reserved in advance. For all microsurgical procedures, Residents are expected to practice prior to the surgical procedure. S/he should schedule time with the appropriate staff to review microsurgical technique and principles. Most surgical cases performed laparoscopically or hysteroscopically are short-stay procedures and are discharged home the same day. If patients are admitted post-operatively, the Resident will manage the patient's post-operative course under the direction of the Attending Physician. At the completion of surgery, patients receive a written evaluation of their management of the case.

TLH Service: TUES/FRIDAY 7:30 a.m.

Faculty schedule private cases at TLH through the Fertility Clinic. The Resident may inquire about assisting on these cases by asking the office nurse (Laurie B 780-4645). Residents are expected to follow patients after the completion of the surgical procedure, either until their discharge from outpatient surgery in the case of one-day stay patients, or through their convalescence and discharge, in the case of patients with more extensive surgeries. Residents may also schedule cases with community physicians (Fertility Institute of New Orleans).

Assisted Reproductive Technology (ART) Surgeries: (Scheduled on a per patient cycle basis) Throughout the year, a number of patients will undergo Assisted Reproductive Technology procedures which are conducted at a private fertility clinic and Tulane/Lakeside Medical Center. These procedures include controlled ovarian hyperstimulation, in-vitro fertilitization, gamete intrafallopian transfer, intracytoplasmic sperm injection and intrauterine insemination. Residents are made aware of upcoming procedures so that they may make themselves available for observation at the appropriate venue. Residents may observe cases performed by Tulane and community physicians.

Hysterosalpingogram: (HSG)

HSG's for patients at UH are performed by the resident. HSG's at TUHC are performed by faculty. Residents are encouraged to attend these procedures, when possible.

Laparoscopy Skills Training:

The REI resident will be expected to participate in the laparoscopy training program, in the Laparoscopy Training facility on the eight floor of the TUMC. The REI resident is expected to complete all basic and advanced modules. Time has been set aside during the REI and Urogynecology rotations for the resident to complete this training. Training consists of the following: Virtual Reality Laparoscopy Simulator: The VRLS provides 12 different laparoscopic tasks the resident will complete. Each task will be performed three times and timed, to establish a baseline. Video-Laparoscopic Training Stations (UT-Southwest training modules): Resident will complete tasks at five video-laparoscopic training stations. Each task will be performed three times and timed, to establish a baseline. After completing the baseline tasks, the Resident will practice on the VRLS and VLTS training stations until s/he meets the established standard times (in duplicate sessions). Once each training station has been mastered s/he will move on to the next skill. It is expected that the basic skills modules should take no more than eight hours. Lab is open for the REI and Urogynecology resident at 8 AM on Tuesday morning for one hour. The REI resident is expected to attend the lab on a weekly basis. The Resident is allowed one absence. After a second absence, readmission to the program will only occur after a meeting with the Chairman of the Department of Surgery, Dr. Hewitt.


Grading of resident experience is based on attendance, general knowledge of REI, oral presentation, global rating scale of operative performance, and professionalism. During the rotation, the resident is required to read 6 chapters from Speroff, and will take a test covering the information presented in each chapter prior to completing the rotation. For further information concerning evaluation, contact either Shelly (988-5216) or Dr. Clisham (988-2285).

Other Responsibilities

The rotation also provides an excellent opportunity for the Resident to begin writing his/her senior research paper.

Suggested Readings

  1. SPEROFF: Clinical Gynecologic Endocrinology and Infertility (5th edition; 6th edition available in October 2010)
  2. SCHLAFF: Decision Making in Reproductive Endocrinology
  3. Fertility and Sterility Journals (Red) - current editions.
Section Members

P. Ronald Clisham, Section Chief