Fellowship Training Structure
The fellowship is currently structured to provide one year of research experience followed by two years of clinical training.
Research Year (Year 1)
The first year fellow is not assigned any clinical responsibilities and participates in the clinical call schedule only for weekend call every third week. The fellow will select a thesis and thesis advisor. The project must lead to completion of a thesis suitable for subspecialty board examination. This project may be laboratory-based basic or translational science or non-laboratory-based epidemiology or outcomes-research. The educational objectives of the research year include many, but not necessarily all, the following:
1. The division objective for basic and translational science research activity focuses on the molecular biology of gynecologic neoplasms, specifically ovarian, and to a lesser extent, endometrial and cervical cancers. a) Mastery of basic laboratory techniques used in molecular biology such as DNA/RNA extraction, DNA analysis (Southern blotting and sequencing), RNA analysis (Northern blotting), PCR, and immunohistochemistry, b) An understanding of the basic concepts of molecular biology,
2. The division objective for epidemiology and outcomes-based research activity focuses on gynecologic neoplasms. a) Mastery of clinical trial design, b) Preparation of IRB applications, c) Understanding of basic concepts of epidemiology, population-based statistics, outcome measures, and interpretation of data.
3. All fellows will be expected to learn the following during their research experience: a) Improvement of skills related to the critical analysis of published data, b) An understanding of why collaborative research is important and how to establish these interactions, c) The development of manuscript writing skills and exposure to grant preparation
4. These educational objectives are accomplished by providing a structured research experience in which the fellow is expected to devise and implement a research plan, interpret the results, trouble-shoot experimental failures, and prepare a manuscript describing the work.
5. The selection of the thesis research project is based upon input from the prospective fellow, the program director, and the project director (if different from the program director). Upon notification of matching and acceptance of the fellowship training offer, the fellow is provided a list of potential mentors and projects. The fellow can choose from this list or suggest his or her own project after discussing the options with the Program Director. If the fellow has a specific project in mind, every effort will be made to accommodate that interest. In special circumstances, clinical research projects will be considered acceptable. Examples include projects related to epidemiology or outcomes research that involve significant participation with the School of Public Health. The project that is selected must have scientific merit, be related to some aspect of gynecologic oncology, and have achievable goals. The activities of the research year are expected to result in at least one peer review publication.
6. Fellows may establish mentor relationships with distinguished researchers in other departments when the program director feels it best suits the particular research interests of the fellow.
7. Clinical research activities include institutional studies, quality improvement studies, and participation with two national collaborative groups. The division enrolls patients in NRG/Gynecologic Oncology Group (GOG) protocols and institutional protocols. An important ancillary goal of the two years of clinical training is to provide a framework in which the fellow can learn to balance the demands of clinical care with those of scholarly pursuits, including ongoing laboratory research and manuscript preparation.
Clinical Years (Year 2-3)
Fellows actively participate in all aspects of in-patient and out-patient care of patients with known or suspected gynecologic cancer, including evaluation, planning, treatment and follow-up at both the University of Michigan Hospital and Saint Joseph Mercy Hospital in Ann Arbor. Structured in-patient and out-patient services incorporate the participation of gynecologic oncology fellows in all patient care activities. Faculty consultation is available to the fellows at all times. Formal teaching rounds at UMMC are conducted regularly by the faculty. The attending faculty agree that day-to-day patient care decisions will be left to the fellow as appropriate for the individual fellow’s level of training and experience.
Gynecologic Oncology is a multidisciplinary specialty where the provider is expected to be able to perform a wide variety of surgical procedures including bowel surgery and urologic surgery in addition to gynecologic procedures. The University of Michigan strictly follows the ABOG Guide to Learning in Gynecologic Oncology. The fellows gain experience on all of these procedures while on the gynecologic oncology service at the University of Michigan because bowel and urologic procedures comprise a significant portion of our routine clinical services.
The fellow obtains Advanced Cardiac Life Support (ACLS) certification before beginning the clinical portion of the fellowship program. On the surgical oncology / breast care center rotation the fellow participates in the capacity of a senior level house officer.
Fellows are not recalled to the gynecologic oncology service when on an off-service rotation unless a rare procedure such as a pelvic exenteration is to be performed. This minimizes disruption to both services and permits the fellow to take on a greater level of responsibility on the off-service rotation. Fellows continue to share weekend rounds when the off-service rotation does not involve weekend clinical duties.
Gynecologic Oncology Tumor Board: This multidisciplinary conference is held with the Department of Radiation Oncology, the Division of Surgical Pathology, and the Division of Medical Oncology every Wednesday afternoon. All patients with newly diagnosed gynecologic cancer who require formulation of a treatment plan, as well as patients who require a new treatment strategy because of a change in disease status, are discussed and the pathology is reviewed. Residents prepare patient care summary notes and present the clinical history. The fellows prepare the presentation list, and review any radiographic studies of interest. Following review of the pertinent pathology, the fellow proposes a management plan with citation of current literature and assessment of protocol eligibility. Following a discussion with the attending faculty, a plan of management is formalized and recommendations for treatment established.
Fellow Didactics: This is a weekly meeting. Reading material on a clinical or basic science topic is assigned to each fellow and is discussed by one of the attending faculty. Particular attention is given to pharmacology of chemotherapy, surgical methods, and areas of controversy or new research. Anatomy review with dissection of a cadaver is offered every 3 years.
Division of Gynecologic Oncology Academic Conference Day: This bimonthly conference is divided into a faculty-led oncology journal club, a fellow-led peri-operative case discussion with pertinent literature review, a fellow-led chemotherapy case discussion with literature review, a research seminar with current research data presented by any member in the division (or guests from other areas), and the division administrative meeting including the monthly Graduate Education Committee for review of fellowship issues. Residents are invited to attend some of the sessions, but the educational level of all of the conferences is at the fellowship level.
Fellowship Common Curriculum: The department of Obstetrics and Gynecology has nine fellowship programs. The seminar is mandatory for all fellows in the department. Guest speakers are invited and each session is designed to showcase and analyze actual examples of each fellow’s work or interests as the center of discussion. Each session has a segment dedicated to:
- Research development (grant funding mechanisms, grant writing, research administration, IRB applications, formulation of hypotheses, statistical interpretation)
- Presentation skills (public speaking, PowerPoint skills, video editing, poster preparation, manuscript writing)
- Teaching skills (adult learning, teaching styles, dealing with the difficult student, assessment tools)
- Academic career development (academic career options, time management skills, evaluating contracts, malpractice issues, preparation of a C.V.).
Morbidity and Mortality Conference (M&M): This is a Department of Ob/Gyn conference that is held every Monday. A list of all patients admitted to the gynecologic oncology service during the preceding week is prepared by the senior resident assigned to the service. Cases of interest and those with complications are presented by the senior resident to the conference participants, which include departmental faculty, residents and fellows. The gynecologic oncology faculty and fellows are available to clarify patient presentations, answer questions, and offer pertinent teaching points.
Department of Ob/Gyn Grand Rounds: This is a weekly meeting held every Thursday morning. The gynecologic oncology fellows are encouraged to attend, although not all topics are pertinent for the oncology curriculum. The fellow is expected to present a scholarly talk at the Departmental grand rounds prior to graduation.
Teaching by Fellows
Fellows are expected to participate in the education of residents and medical students. Two or three residents at different levels of training, one or more medical students, and one pharmacy student are usually assigned to the division for each rotation. The rotations are one month in duration for the residents and pharmacy students, and one to two weeks in duration for the medical students. Residents and medical students function as important members of the health care team under the direction of the gynecologic oncology fellows. This relationship exists in the ambulatory patient clinics, the inpatient service, and the operating room. In addition to teaching on daily work rounds and in the operating room, fellows are asked to prepare and deliver formal lectures and seminars for the resident core curriculum and to lead discussion at department journal clubs.