Fellowship in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology)
This accredited three-year fellowship has been training fellows for over ten years and provides a comprehensive approach to pelvic floor disorder management. Fellows will receive a broad spectrum of surgical training, and by graduation will be highly skilled in performing laparoscopic, vaginal and robotic surgery as well as maintaining skills in abdominal surgery. Clinic experience includes a wide variety of outpatient urogynecologic evaluation and treatment as well as office procedures such as neuromodulation and Botox injections. The Division consists of four fellowship trained urogynecologists and a senior gynecologist with advanced laparoscopic skills. A colorectal rotation and urology experience are provided. We are affiliated with Harvard Medical School and are involved in teaching residents from a Harvard affiliated tertiary care center.
Research time is divided into blocks that increase with successive years in training. Extensive research resources are also available from the greater Harvard community.
FPMRS fellows do not have any obstetrical obligations.
Fellows are matched one-to-one with a faculty member in all clinical activities. Additionally there is sufficient clinical and support staff that allows fellows to focus in educational aspects of clinical time. Fellows are always involved, however, in assessing complicated issues and participate in decision making and treatment plans.
We have a large number of faculty that are very interested and engaged in teaching the fellows. We have teaching faculty in FPMRS as well as Gynecologic Oncology to teach anatomy and surgical skills, both open and minimally invasive. Colorectal surgery is a resource at the BIDMC with fellows participating in both clinics specific to pelvic floor dysfunction as well as relevant cases in the operating room. Additionally, the Radiology department is a great resource at Mount Auburn Hospital. Dr. Sasson, who is part of our teaching faculty, has a specific interest in pelvic floor dysfunction and the use of MRI to evaluate anatomic defects and correlate with functional deficits in women. We have quarterly joint teaching conferences with Dr. Sasson and the radiology residents, including case presentation and review of related imaging. He is also readily accessible to review individual cases on an as needed basis with the fellows.
Our fellows follow a curriculum with goals and objectives based on The Guide for Learning for FPMRS. Each fellowship year has a rotation schedule that allows for graduated responsibilities commensurate with experience and training, as well as exposure to pertinent subspecialties. The fellow can prioritize their educational experience based on their needs in consultation with the Program Director, especially in the third year of training. We do give priority to surgical experiences as opportunities for office experience is constant during the week. However, there is a set weekly schedule for the fellows based on surgical and clinical scheduling determined and reassessed at least weekly. This schedule is overseen by the third year fellow in consultation with the Program Director and ensures that all cases are covered and that all fellows have the opportunity to achieve expertise in a range of cases. In addition, this ensures that all fellows have the opportunity to go to unusual or complicated cases.
The program seeks to teach fellows the ability to critically analyze and review literature, develop a hypothesis and design clinical trials to test hypotheses and outcomes. Fellows work with our statistician to learn how to collect and analyze their data so that meaningful clinical question is answered. In addition they learn how to present their findings orally and in written form through writing papers and giving presentations. The second year fellow must identify a thesis topic, develop the protocol, and manage the study and data collection. This thesis is then defended at a Grand Rounds at Beth Israel Deaconess Medical Center towards the end of their third year.
The current design of our fellowship program encourages fellows to have independent projects from the first month of fellowship. There is dedicated academic time from the beginning of the fellowship that progressively increases with each fellowship year. Fellows are encouraged to think of their research interests and develop research projects appropriately. Fellows are encouraged to think of their research interests and develop research ideas immediately, even if the study is a simple retrospective chart review or case series initially. This starts the scientific thought process, familiarizes them with the process of setting up a data base, writing a protocol and presenting it to the IRB.
Fellows continue to develop more involved hypotheses and study designs through the three years of fellowship. We expect fellows to participate and take charge in multiple high quality research studies that lead to publication.
Mentorship is provided by all faculty members jointly during the monthly research conferences as well as individually in the office setting. The proximity of the fellow and attending offices allows frequent dialogue and feedback on a near daily basis. Principles of clinical research that are reviewed include study design and implementation, study recruitment, protection of human subjects and data analysis. We also discuss abstract and paper submissions. In the group setting, fellows’ ideas are discussed and multiple insights are incorporated as well as ideas for development and implementation. Fellows also receive specific one-on-one feedback from the principle investigator of each study. However, all faculty members are available to answer questions regarding issues that arise day to day. Faculty members also ensure that fellows have adequate academic time to complete their projects.
We are fortunate to have Michele Hacker, Scd, MSPH, who is a steady resource to our fellows in all aspects of study design, implantation, analysis and writing. She teaches statistics as well as study design considerations and statistical considerations in a formal didactic session as well.
Additionally we have an experienced research coordinator who teaches our fellows to navigate the IRB, consider their studies in the setting of compliance to all ethical and regulatory rules and facilitates their understanding of proper protocol submissions and requirements.
The twice monthly journal clubs are used to review current as well as historic literature. We also use this time to dissect study design, methodology and flaws in published studies. We also discuss different ways specific studies might have been approached.
Fellows are also encouraged to participate in studies through the fellows’ networks to learn the process of multi-center collaboration and working within a network.
Education and Didactic Experience:
There are at least two hour of didactic time each week in FPMRS, as well as departmental activities at Mount Auburn Hospital and BIDMC. Below is a list of activities fellows can expect to participate in:
- Didactics (1-2 times per week)
- Journal Club (1-2 times per month)
- Morbidity and Mortality Conferences (monthly)
- Seminars (2 times per year)
- Quality Assurance Committee (Fellows attend at least 2 times per year)
- Preoperative Case Conference (2 times per month)
Harvard Catalyst Program:
The fellows also have the Harvard catalyst program as a steady resource. The Harvard Clinical and Translational Science Center is dedicated to improving human health by enabling collaboration and providing tools, training and technologies to clinical and translational investigators. Harvard Catalyst is a member of the NIH-funded Clinical and Translational Science Award (CTSA) Consortium and a shared enterprise of Harvard University, its ten schools and its seventeen Academic Healthcare Centers (AHC), as well as the Boston College School of Nursing, MIT, Harvard Pilgrim Health Care, and numerous community partners.
Harvard Catalyst offers clinical and translational investigators what they need to conduct clinical experiments, including clinical research nursing, research dietician support, experimental design assistance, sample processing, data management, and information about core facilities. These resources are available to all Harvard faculty and fellows, regardless of their institutional affiliation or academic degree.
The BIDMC also offers several workshops throughout the academic year on research related issues, grant writing, quality and safety seminars that are available to the fellows.
The Harvard Library and MAH Library are easily accessible to our fellows. Online Harvard library access and ECommons through Harvard Medical School are also readily available at any remote locations. Print journals such as FPMRS, IJUG and AJOG are available in our office. Textbooks and Atlases are kept in the office library.
Additionally, each fellow has a guaranteed CMEallocation that allows for travel to conferences and specialty specific educational courses. There are several educational and support resources through Harvard Medical School that our fellows have utilized. Most of our fellows pursue a clinical research or administrative leadership track, however basic science experience is available through the medical school as well as our affiliate Beth Israel Hospital for those who express an interest. Courses offered at Harvard Medical School allow the fellow the option to have a rigorous didactic experience that will supplement and compliment the education that they receive in their three years of training. Our fellows have utilized the Catalyst course in statistics. In addition to providing a comprehensive yearly statistical course, the Catalyst program provides statistical and logistic support for fellow research projects.
Call, Duty Hours and Moonlighting:
On average, fellows will have at least one full day out of seven free from educational and clinical responsibilities, with the longest continuous shift no more than 12 hours as there is no “night float” assignment and an average work week of 50 hours.
Fellows can do Gynecology only call that does not require an in-house stay and does not interfere with their duties or fellow education on a case-by-case basis as deemed appropriate by their Program Director. In addition, moonlighting hours must not raise their duty hours above 60 hours per week. The fellow must also be in good standing with the department. There is no “requirement” to moonlight and our fellows infrequently engage in moonlighting.