Clinical Experience

Educational Objectives:

Over the course of the fellowship, all fellows will participate in semi-weekly didactice sessions.  Reading material on a clinical topic is assigned to the fellows and is discussed with the attending faculty.  Particular attention will be given to areas of controversy and new research.  Topics to be discussed will be as follows and will utilize the most recent literature and/or text books:

  1. Laparoscopy equipment and instrumentation, with an emphasis on electrosurgery.
  2. Laparoscopic pelvic anatomy
  3. Selection and counseling of patients for endoscopic surgery
  4. Patient positioning and trocar placement
  5. Operative hysteroscopy: patient selection, instrumentation, and surgical approach
  6. Acute intraoperative and postoperative complications of laparoscopy
  7. Acute intraoperative and postoperative complications of hysteroscopy
  8. Adhesion prevention and management
  9. Laparoscopic approach to hysterectomy
  10. Laparoscopic myomectomy
  11. The role of cystoscopy and evaluation of urinary tract injuries in gynecologic surgery
  12. The evaluation and management of the patient with an adnexal mass
  13. Overview of the evaluation of the patient with chronic pelvic pain
  14. Role of the central nervous system in chronic pelvic pain
  15. Pathophysiology and immunology of endometriosis
  16. Medical management of endometriosis-associated chronic pelvic pain
  17. Surgical management of endometriosis
  18. Musculoskeletal causes of chronic pelvic pain
  19. Evaluation and management of interstitial cystitis
  20. Evaluation and management of irritable bowel syndrome
  21. Overview of the pathophysiology, evaluation and treatment of vulvodynia
  22. Hormone replacement therapy and menopause
  23. Evaluation and management of abnormal uterine bleeding
  24. Medical and surgical treatment options for symptomatic uterine fibroids

Overview of Clinical Responsibilities

Fellows actively participate in all aspects of in-patient and out-patient care of women with complex gynecologic conditions. Structured in-patient and out-patient services incorporate the participation of MIS fellows in all patient-care activities. Faculty mentorship and consultation are available to the fellows at all times. 

Fellows will have the opportunity to work within MIS faculty clinics and obtain one-on-one training in the evaluation and management of complex gynecology patients.  All surgeries scheduled from MIS faculty clinics will include fellow participation.  Fellows will also see patients in their own clinic ½ day per week, except when off-service.  This is an opportunity for the fellows to maintain continuity with their own patients, and to evaluate and schedule patients for surgery on their own.  During the first year of fellowship, a faculty member will be immediately available for consultation for clinic patients and will staff the fellow’s cases.  In the second year, fellows can schedule cases independently within MIS block time, and faculty will be available for back up upon request.  These cases will be in addition to time spent in the OR with MIS faculty, and does not serve as a replacement.

Types of procedures that a fellow is expected to master include the following:

  1. laparoscopic hysterectomy (traditional and robotic)
  2. laparoscopic myomectomy (traditional and robotic)
  3. laparoscopic excision of advanced endometriosis, including pelvic sidewall dissection
  4. laparoscopic ovarian cystectomy and adnexectomy
  5. excision of ovarian remnant
  6. Minlaparotomy for abdominal myomectomy and hysterectomy
  7. Hysteroscopic myomectomy, lysis of adhesions

Off-Service Rotations

All MIS fellows at the University of Michigan will have the opportunity to spend one month per year on the urogynecology service and the gynecologic oncology service within the Department of Obstetrics and Gynecology at The University of Michigan.  The MIS fellow will be fully integrated into these off-service rotations within the department, and their respsibilities and schedule will be determined by the fellowship director for each division (Dr. John DeLancey for urogynecology and Dr. Kevin Reynolds for gynecologic oncology).  During these rotations, the MIS fellow will have the opportunity to participate in the medical and surgical care of patients on these services.  In doing so, MIS fellows will gain important exposure and experience in the preoperative evaluation of urinary and fecal incontinence, urogenital prolapse, as well as the screening and evaluation of gynecologic malignancies.  The fellows will also operate with each service, and will gain valuable experience in prolapse and incontinence procedures, as well as radical pelvic surgery including laparoscopic GYN cancer staging procedures.

Teaching by Fellows

Fellows are expected to participate in the education of residents and medical students. A third or fourth year resident and one medical student are usually assigned to the division for each MIS rotation. The rotations are one month in duration for the residents 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 MIS 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.

Fellow call responsibilities:

  • GYN call and UMOG call:  Fellows will participate in the benign gynecology and UMOG call pools.
    • The benign gynecology attending call is taken from home approximately 3 times per month.  This attending is responsible for inpatient and emergency department consultations and admissions when the UMOG attending is unavailable, and is responsible for any emergency surgical procedures. 
    • The UMOG attending call is an overnight, in-house call that is taken 1 times per month.  The UMOG attending supervises the on-call Ob-Gyn residents in all of their clinical activities, except for emergency gynecologic procedures.  This includes the obstetric service.  Participation in the UMOG call is optional, but encouraged.  Faculty will receive an additional stipend for each UMOG call taken.
  • MIS service:  MIS fellows will be available for residents to discuss and evaluate MIS patients who are admitted to the hospital or present to the ED for evaluation of postoperative complications.  Fellows will share the call responsibility, and call schedule should be posted to the groupwise Obgyn call calendar.  In general this should be covered by the OR fellow, but can be adjusted according to individual scheduling needs.  If no fellow is available, notify MIS faculty.