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Curriculum

The first year of the Mayo Clinic Female Pelvic Medicine and Reconstructive Surgery Fellowship is dedicated to research with no clinical responsibilities. You enroll in the Mayo Graduate School Masters of Biomedical Science in Female Pelvic Medicine and Reconstructive Surgery program; and the Center for Translational Science Activities (CTSA) certificate program. The master’s and CTSA certificate programs are designed to prepare fellows to lead and participate in research teams conducting effective patient-oriented research.

Master's Degree minimum credit requirements

You must complete 16 credits of required didactic courses, with a minimum grade point average of 3.0 (on a 4.0 scale). You earn 24 credits towards the Master’s degree for participation in structured research activities; and 28 credits towards the Master’s degree for participation in departmental clinical and surgical training.

You may enroll in additional elective courses offered by the Mayo Graduate School after discussion and approval by the graduate program director. Completion of the Master’s degree requires successful completion of a thesis manuscript, written examination, and oral defense of the thesis.

Whether pursuing clinical or basic science research, the first year of fellowship is organized to teach trainees how to generate a hypothesis and coordinate the necessary technology to test a hypothesis. Following the first year dedicated to research, you have the opportunity to complete several manuscripts during the remaining two years of training.

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

An example of the fellowship rotations:

Summer Quarter Fall Quarter Winter Quarter Spring Quarter
Year 1 Research Research Research Research (BLS & ACLS certification)
Year 2 Gyn Surg & Incontinence Clinic Gyn Surg & Incontinence Clinic Gyn Surg & Incontinence Clinic GI/Manometry (2 wks)
Year 3 Gyn Surg & Incontinence Clinic (Written Exam) Gyn Surg & Incontinence Clinic (4 wks)/Off-Campus Female Urology at Metro Urology in Woodbury, MN (8 wks)-Required (Oral thesis defense) Gyn Surg & Incontinence Clinic (6 wks)/C&RS (6 wks) Gyn Surg & Incontinence Clinic

In-patient and out-patient activities and related clinical instruction occur on alternate weekdays at Mayo Clinic. You participate in clinic one day and 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 conduct early morning hospital rounds at Mayo Clinic Hospital, Methodist Campus, evaluating the pre- and postoperative status of patients and formulating management plans. Fellows then join a supervising faculty and revisit all inpatients for morning teaching rounds. During these rounds, fellows discuss the patients' conditions and modify management plans if necessary. Fellows and faculty 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 perform urodynamic and cystoscopic patient evaluations; and complete the day with final hospital work rounds.

On surgical days, fellows conduct early morning and late afternoon hospital work rounds as described above. Fellows begin surgery at 7:45 a.m., working one on one with one of four urogynecologists for intraoperative instruction. You are assigned to a urogynecology faculty on a quarterly basis; and participate in clinical and surgical teaching for residents and medical students.

The faculty members have excellent relationships with other related departments including general surgery, colorectal surgery, neurology, gastroenterology and urology, enhancing clinical care of gynecologic patients and broadening fellow medical and surgical exposure. During the two-year clinical course of the fellowship, fellows rotate in gastroenterology (two weeks), colon & rectal surgery (six weeks), and female urology (required eight-week off-campus rotation at Metro Urology in Woodbury, Minn.).

The urogynecology surgeons focus on prolapse, urinary incontinence and complex benign gynecologic problems. You participate in procedures, including:

  • 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, fellows perform intraoperative cystoscopy for surveillance of the urinary tract as well as for placement of intraoperative ureteral stents and Botox injection. Fellows are trained in sacral nerve stimulation.

In addition to the operative procedures, fellows are trained in diagnostic procedures in the clinical setting including:

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

The degree of independence fellows have in performing any of the above procedures is determined by clinical and surgical experience as well as the complexity of the surgery required to care for the patient. However, overall fellow responsibility will increase commensurate with professional growth. For example, during the first several months after you begin the clinical rotations, you function as an assistant to the faculty surgeon until familiar with Mayo's approach and techniques. These roles are reversed during the final six months of training. This same process occurs in both the outpatient and the inpatient postoperative settings.

In addition, the Mayo Clinic gynecologic surgical staff consists of several gynecologic oncologists who perform both benign and oncologic surgical procedures. You are exposed to many different types of gynecologic procedures and approaches during assignments. This ensures that fellows 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. Fellows attend one of the following didactic sessions every Tuesday morning:

  • Urogynecology Fellowship Research Conference
  • Urogynecology Fellowship Journal Club
  • Urogynecology Fellowship Conference
  • Urogynecology Fellowship Quality Improvement (M&M) Conference

Fellows attend the conferences noted above in addition to the didactic training in pursuit of the Masters of Biomedical Science in Female Pelvic Medicine and Reconstructive Surgery. In addition once a year, a 6-week Pelvic Anatomy Course is offered and is a requirement for the fellows. Several other conferences are offered including the Obstetrics & Gynecology department conference, general surgery conference, and OB/GYN journal club.

Fellows attend the annual meeting of the American Urogynecologic Society (AUGS) at least once during fellowship and may attend each year if an abstract is accepted for the conference. Fellows may attend other scientific meetings if an abstract is accepted for presentation.

Research training

The research opportunities at Mayo Clinic are significant. The urogynecology team focuses 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 facilitates investigation in a variety of areas. You are expected to generate research projects resulting 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. You utilize this service for proofing, formatting and submission process for manuscripts.

Call frequency

Fellow call schedule will vary by individual rotation. Fellows are on pager call for the assigned surgical service every weekday and weeknight. The weekend call is rotated and averages once a month. Fellows have no in-house call.

Mayo Clinic complies with the Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements.

Moonlighting

Moonlighting is not required. Moonlighting is allowed with permission of the program director and must comply with ACGME duty-hour requirements. Moonlighting must not interfere with any fellowship responsibilities.

Evaluation

To ensure that fellows acquire adequate knowledge and development of technical skills, performance is monitored carefully during the course of fellowship. You are evaluated formally by supervising faculty member on a quarterly basis, and these evaluations are shared with each fellow by the program director.

In addition, fellows regularly evaluate the faculty, rotations and fellowship program to ensure your needs are being met.

  • Dec 13, 2013
  • ART403031