Female Pelvic Medicine & Reconstructive Surgery Fellowship

Our surgical training program includes a large volume of high complexity cases with substantial educational benefit.  Our national reputation in gynecologic surgery results in referral of patients with complex problems that provide ideal learning opportunities.  You will rarely see anything after fellowship that you have not seen during training. 

• Each fellow performs surgery on 150 to 200 patients per year. 
• 40% of our operations are for recurrent disease so that fellows are comfortable with complex surgery.
• Faculty have diverse approaches to surgery including robotic, laparoscopic, open and vaginal methods so fellows get experience with each route of operation; especially vaginal. 
• We have an advanced simulation center with multiple training consoles for straight-stick laparoscopy, as well as the entire DaVinci SI training system (including docking console, OR table and mannequin patient) to enhance laparoscopic skills.

Michigan Medicine has benefited from a great collaboration between Urology and Gynecology (first program to be jointly approved for both Gynecology and Urology) and is often considered the exemplar of cooperation. The Neurourology and Pelvic Reconstruction (NPR) fellowship in Urology accepts one urologist per year and there is extensive interaction between the programs to maximize education for both specialties. Our philosophy is not to train everyone to do everything, but to train sub-specialists in each program who are able to handle the most challenging problems that are likely to be referred to them.  By spending time on the NPR service, each fellow gets firsthand experience with operations and diagnostic testing that they may not choose to offer, but will need to know about to collaborate in the future.  In addition, specialized knowledge such as management of spinal cord injured patients is maximized.

This is a multidisciplinary program with gynecologists, gastroenterologists, colorectal surgeons, physical therapists, and specialized nurses working together that provides a great opportunity for fellows to gain experience in the management of the posterior compartment problems and comprehensive knowledge of the inter-relationship of GI function and gynecologic disease.  Experience in this clinic provides a deeper understanding of the clinical aspects of bowel problems. Patients from this clinic frequently undergo concomitant surgical treatments by faculty from Colorectal Surgery and FPMRS, providing the fellows with the opportunity to participate in colorectal procedures.

Learn more about the Michigan Bowel Control Program.

This unique program involves physicians, specialized nurses, social workers, physical therapists and more to provide comprehensive postpartum care to new mothers. Fellows will learn how to evaluate and manage a multitude of pelvic floor issues in the postpartum period including: 3^rd and 4^th degree perineal tears, complications of perineal wound healing, urinary and fecal incontinence, urinary retention, and dyspareunia.  

Learn more about the Michigan Healthy Healing After Delivery Program.

The Pelvic Floor Research Group at Michigan Medicine is an award-winning group of investigators devoted to discovering new insights important to advancing pelvic floor treatment and prevention.  Its investigators have received over $20 million dollars in NIH funding over the last 20 years which provides a strong infrastructure for research. 

Many disciplines are represented in the Pelvic Floor Research Group. This allows us to offer fellows a diverse set of opportunities to choose from for building research focus.  The following list indicates the areas in which we have active collaborations and a record of funding and publication:

• Pelvic floor functional anatomy
• Biomechanics of the pelvic floor
• MRI based 2D and 3D projects
• Clinical outcomes and quality improvement
• Epidemiology of pelvic floor disorders
• Cost-benefit and decisional analysis
• Health services research
• NIH funded multi-center research groups (MAPP and LURN)
• Urologic research, especially in neurophysiology and painful bladder syndrome
• Complications of delivery and enhancing postpartum recovery

Recent Research:  You can visit our website for more details about our research via this link: https://medicine.umich.edu/dept/obgyn/research/programs-units/pfrg.

Another unique resource available to fellows is access to the Michigan Surgical Quality Collaborative (MSQC), a statewide surgical improvement collaborative that includes over 60 community and academic hospitals across the state. The ongoing database collects data on hysterectomies done in the state of Michigan. With over 500 variables abstracted per hysterectomy case, this database offers ample research opportunities regarding gynecologic surgery as well as experience using a large database.

Didactic sessions occur weekly on Friday mornings. They consist of chapter and literature review following the ABOG guide to learning in FPRMS. The goal is to optimally prepare fellows to understand the existing knowledge and sentinel research studies of our specialty, as well as prepare them for board examinations.

Thursday afternoon is reserved for teaching and service issues.  We review all cases for the next week and teach about surgical planning and operative strategy.  The fellows take pictures and videos of interesting cases which are reviewed at this time.  Topics rotate to include the following each month: topic-specific lecture/book chapters, journal club, quality improvement, and fellows' research "round-up." The latter is an opportunity for fellows to present research ideas and get help with protocol design, abstract writing, presentation preparation, and manuscript development. Weekly Didactic sessions are also held on Friday mornings.

Fellows get extensive training in skills both for presenting at postgraduate lectures and national meetings, as well as for producing surgical videos.

• Native Tissue Anterior Repair: Key Steps for a Successful Outcome. Carolyn Swenson, MD
• What You See is What You Get: The Anatomy of Apical Support.  Erin Crosby, MD
• Michigan 4-wall Sacrospinous Ligament Suspension.  Kindra Larson, MD

Our department, in particular, and the schools of medicine and public health, in general, have strong programs in Global Outreach.  The Department of OB/GYN has a long-standing collaboration in Ghana and Ethiopia.  

Our fellows’ salaries are paid by GME funds from the hospital and, as such, fellows are not required to cover obstetrical call or non-FPMRS clinics.  The fellows take call from home on a rotating basis for service patients and are available to help with calls from other services, such as obstetrics, if a bladder injury or difficult perineal laceration could benefit from sub-specialty assistance.

The fellows are a part of the University of Michigan House Officer’s Association which has many benefits for the residents and fellows throughout the institution.  For more information, including a copy of the employment contract, you can visit  http://www.umichhoa.com/.