Curriculum

The first year of Mayo’s Female Pelvic Medicine/Reconstructive Surgery Fellowship consists of dedicated research.  During this year of dedicated research, no clinical responsibilities are required of you.  A Master’s Degree in Clinical Research is offered and is highly recommended.  This is an extensive program that prepares the individual for a career in research design, execution and analysis. 

Master's Degree Minimum Credit Requirements

Students must complete 24 credits which are approved by the Clinical Research Training Program (CRTP) Education Committee with a minimum grade point average of 3.0 (on a 4.0 scale) as required by the Mayo Graduate School.  

The curriculum consists of 14 required credits and 10 elective credits from either the Clinical Research (CR) or Health Science Research (HSR) electives or any other course listed in the Mayo Graduate School catalog.  

Elective courses outside the CR or HSR discipline will need approval by the CRTP Admissions/Matriculation Subcommittee.  At least one-half of the credits taken and included in the degree program must be graded under the A-F system. It is expected that a minimum of one year will be devoted to research.

Also see

• Clinical Research Training Program at Mayo Clinic

In addition to the Master’s Degree in Clinical Research, if you have a desire to pursue basic science research, we offer several opportunities for this.  Designated basic scientists in biochemistry and experimental biology as well as microbiology have allocated space and can serve as mentors. 

Whether pursuing clinical or basic science research, the year is organized to teach you how to generate a hypothesis and coordinate the necessary technology to test your hypothesis.  Generally, several manuscripts will be produced during your three-year fellowship. 

During the final two years, you will receive extensive medical, surgical and diagnostic training in female pelvic medicine and reconstructive surgery.  You will gain hands-on experience in evaluating, diagnosing and managing patients with urinary incontinence, pelvic relaxation and a wide variety of disorders of the female reproductive track. 

An example of the fellowship rotations:

Most in-patient and out-patient activities and related clinical instruction occur on alternate weekdays at Mayo Clinic.  Essentially you are in clinic one day and doing surgery the next in an alternating manner.  The list below shows a typical week.

Non-surgical days:

• Hospital work rounds – a.m.
• Staff teaching rounds
• Urogynecology Clinic
• Hospital work rounds - p.m.

Surgical Days:

• Hospital work rounds - a.m.
• Gynecologic surgery
• Hospital work rounds - p.m.

On nonsurgical days, you will conduct early morning hospital rounds at Rochester Methodist Hospital evaluating the pre- and postoperative status of patients and formulating management plans.  You will then join a consulting staff member and revisit all inpatients for morning teaching rounds.  During these rounds, you will discuss the patients’ conditions and modify your management plans if necessary.  You will then proceed to the Urogynecology Clinic for the balance of the day seeing and evaluating postoperative patients as well as new and returning patients.  During that clinic day, you will perform urodynamic and cystoscopic evaluation of many of these same patients.  You will complete the day with final hospital work rounds. 

On surgical days, you will conduct early morning and late afternoon hospital work rounds as described above.  You will begin surgery at 7:45 a.m., working one on one with one of two urogynecologists who will give you intraoperative instruction.  You will be assigned to a staff consultant on a quarterly basis.  Typically, there are no other house officers assigned to that consultant, thus allowing you a one-on-one learning experience with your assigned consultant.  You will have the opportunity to teach residents and medical students. 

The faculty members have excellent relationships with other related departments including general surgery, colorectal surgery, neurology, gastroenterology and urology.  This enhances the clinical care of gynecologic patients and broadens your medical and surgical exposure.  During the two-year clinical course of the fellowship, you will also be involved in rotations in gastroenterology, colon & rectal surgery, urology, physical medicine & rehabilitation and plastic surgery. 

Most of the clinical experiences, from the gynecologic surgery perspective, will relate to prolapse, urinary incontinence and complex benign gynecologic problems.  Procedures you will be exposed to during your clinical fellowship include, but are not limited to:

• hysterectomy
• bilateral salpingo-oophorectomy
• Mayo-McCall culdoplasty for vaginal vault prolapse
• anterior and posterior colporrhaphy
• urethral diverticulectomy
• autologous and synthetic pubovaginal sling procedures
• retropubic urethropexy
• paravaginal defect repair
• abdominal sacrocolpopexy
• repair of genitourinary injuries including fistula
• repair of urethrovaginal and rectovaginal fistulas
• ureteroneocystotomy along with repair of other injuries to the urinary track
• anosphincteroplasty
• a variety of plastic surgery procedures including McIndoe procedures for creation of a neovagina as well as various rotational flaps for reconstructive surgery

In addition, you will perform intraoperative cystoscopy for surveillance of the urinary track as well as for placement of intraoperative ureteral stents and Botox injection.  Sacral nerve stimulation will also be taught. 

In addition to the operative procedures, you will also be exposed to several diagnostic procedures in the clinical setting including:

• urodynamics
• cystoscopy
• anorectal manometry
• EMG
• endorectal ultrasound
• defecography
• pelvic floor biofeedback

The degree of independence you will have in performing any of the above procedures will be determined by your clinical and surgical experience as well as the complexity of the surgery required to care for the patient.  However, your overall responsibility will increase commensurate with your professional growth.  For example, during the first several months after you begin your clinical phase of the fellowship, you will function as an assistant to the staff surgeon until you are familiar with Mayo’s approach and techniques.  By the time you have reached the last six months of training, it is expected that these roles will be reversed.  This same process should also occur in your work with patients in both the outpatient and the inpatient postoperative settings. 

In addition, the surgical staff consists of several gynecologic oncologists at Mayo who perform both benign and oncologic surgical procedures, so you will be exposed to many different types of gynecologic procedures and approaches during your assignments.  This will ensure that you will have the opportunity to gain superior surgical skills in not only urogynecology and reconstructive pelvic surgery but also with gynecologic oncology cases that have relevance to our stated discipline.

Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are all an integral part of the fellowship.  You will attend the following didactic sessions:

• Urogynecology Research conference
• Urogynecology Journal Club
• Urogynecology didactic conference
• Urogynecology M&M conference

This conference schedule is in addition to the didactic training that one receives in pursuit of the Master’s Degree in Clinical Research.  The above conferences are held every Tuesday morning each month.  In addition once a year, an eight-week Pelvic Anatomy Course is offered and is a requirement for the fellows.  In addition, several other conferences are offered including the Obstetrics & Gynecology department conference, general surgery conference, OB/GYN journal club, etc. 

You will attend the annual meeting of the American Urogynecologic Society while you are in this training program.  In addition, you will attend other annual scientific meetings if you have an abstract, manuscript, oral or poster presentation accepted for the conference. 

Research Training
The research opportunities at Mayo Clinic are significant.  Our focus has been on epidemiology, retrospective and prospective analysis of surgical procedures, imaging modalities of the pelvic floor, surgical outcomes and basic science research. 

An extensive support team has been assembled to facilitate investigation in a variety of areas.  Research is expected to result in manuscripts suitable for presentation and publication in peer-reviewed journals. 

The Section of Publications at Mayo Clinic Rochester is the largest in-house publication service of any academic center in the United States.  They will help in the proofing, formatting and submission process for your manuscripts. 

Call Frequency
Your call schedule will vary by individual rotation.  In general, you will be on pager call for the service that you are assigned to every weekday and weeknight.  The weekend call is rotated and it generally averages once a month.  There is no in-house call required. 

Mayo Clinic follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME) and complies with ACGME’s duty-hour requirements. 

Moonlighting
Moonlighting is not required and is allowed with permission of the program director.  It should not, however, interfere with any of your fellowship requirements. 

Evaluation
To ensure that you acquire adequate knowledge and development of technical skills, your performance will be monitored carefully during the course of your fellowship.  You will be evaluated formally by your supervising faculty member on a quarterly basis, and these evaluations will be shared with you by the program director. 

In addition, you will regularly evaluate the faculty and your educational program to ensure that your needs are being met.