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Curriculum

The first year of the Mayo Clinic Gynecologic Oncology Fellowship consists primarily of gynecologic-related translational science research and didactic course work (see didactic training section below). Mayo Clinic has active federally funded research programs in endometrial and ovarian cancer research and has a National Cancer Institute SPORE grant in ovarian cancer.

Mentors are chosen from basic science researchers actively working in these areas with a strong interest in mentoring and an active laboratory program. These labs are dynamic with a strong focus on translational aspects of gynecologic cancer. Experts are available from most basic science programs, including biochemistry, experimental biology, pharmacology and cell biology. Labs are selected based upon available projects and the trainee's prior interest or experience (when such experience exists).

This experience in laboratory research teaches you how to recognize significant oncologic processes worthy of investigation, generate a testable hypothesis and coordinate the technology necessary to test your hypothesis. The work done during the lab year typically serves as your thesis for the Master's of Biomedical Science in gynecologic oncology program and for your oral American Board of Obstetrics and Gynecology (ABOG) examination in gynecologic oncology.

In addition to the basic science research you conduct during your first year, you begin some clinical research projects carefully chosen with the fellowship director to provide mentorship and dovetail with other commitments. A small portion of time is spent with radiation oncology during the last two quarters of the first year. The focus is on continuity patients receiving radiation therapy for gynecologic malignancies, and you work directly with specialists in radiation oncology.

During the final two years, you receive training in clinical gynecologic oncology, advanced gynecologic surgical oncology, radiotherapy and chemotherapy. Gynecologic oncology surgical rotations are organized on a quarterly schedule. You are assigned to a preceptor with a specific interest in gynecologic oncology, but you also have the opportunity to work with all of Mayo's gynecologic surgeons.

Rotations

Fellows Summer quarter Fall quarter Winter quarter Spring quarter
1st year Fellow #1 Research Research Research/limited Rad Onc experience Research/limited Rad Onc experience
1st year Fellow #2 Research Research Research/limited Rad Onc experience Research/limited Rad Onc experience
2nd year Fellow #1 GYN Surgery/Med Onc GYN Surgery*/Critical Care Service** GYN Surgery*/Colon & Rectal Surgery GYN Surgery*
2nd year Fellow #2 Med Onc/GYN Surgery Critical Care Service**/ GYN Surgery* GYN Surgery* Colon & Rectal Surgery/GYN Surgery*
3rd year Fellow #1 GYN Surgery* GYN Surgery* GYN Surgery* GYN Surgery*
3rd year Fellow #2 GYN Surgery* GYN Surgery* GYN Surgery* GYN Surgery*

*Gynecologic Oncology fellows continue to see patients with a medical oncologist one afternoon every other week when they are on a GYN Surgery quarter.

**Fellows function as a junior resident when on the Critical Care Service (CCS) rotation and are responsible for having Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certification up to date prior to this rotation.

Clinical training

Mayo Clinic rotations are generally structured on an every-other-day cycle between clinical and surgical days. This outline shows a typical weekly schedule:

Nonsurgical days

  • Hospital work rounds (a.m.)
  • Staff teaching rounds
  • Outpatient services
  • Chemotherapy clinic
  • Hospital work rounds (p.m.)

Surgical days

  • Hospital work rounds (a.m.)
  • Gynecologic surgery
  • Pathology and tumor board reviews
  • Brachytherapy (operating room insertion)
  • Intraoperative irradiation
  • Hospital work rounds (p.m.)

On nonsurgical days, you conduct early morning hospital work rounds at Mayo Clinic Hospital, Methodist Campus, evaluating the preoperative and postoperative status of patients and formulating management plans. You then join a consulting staff member and revisit all inpatients for teaching rounds. During these rounds, you discuss the patients' conditions and modify your management plans if necessary.

The balance of the day is spent in clinic seeing and evaluating new, returning and postoperative patients. This includes afternoon consultations for patients returning to the Gynecologic Chemotherapy Unit and postoperative patients needing treatment planning. You complete the day with final hospital work rounds.

On surgical days, you conduct early morning and late afternoon hospital work rounds as described above. You begin with a surgical team meeting at 7:30 a.m. and surgery at 7:45 a.m., working one-on-one with the staff surgeon to provide ample opportunity for learning, growing independence in surgery and receiving daily feedback on progress.

There is an emphasis on surgical experience — including laparoscopic, robotic and open surgical procedures — for gynecologic cancers and complex pelvic operations, including radical upper abdominal debulking of ovarian cancer. These cases also include intraoperative radiation therapy, brachytherapy and the surgical management of complications resulting from radiotherapy.

Assignments

You work with a staff gynecologic oncologist for each three-month rotation in the program. During each rotation, you work as a team with the staff surgeon, physician assistant, nurse and operating room technician.

The degree of independence you have in any given case is determined by your experience and surgical expertise as well as the complexity of the surgery required to care for the patient. Overall responsibility increases commensurate with your growth during the fellowship.

For example, during the first three months of fellowship, you function as an assistant to the staff surgeon to familiarize yourself with advanced retroperitoneal and upper abdominal anatomy as well as Mayo's approach and techniques relevant to gynecologic oncology. This then transitions such that by the last six months of training, it is expected that these roles are reversed. This same process should also occur in your work with patients in both the outpatient and inpatient postoperative settings. Procedural evaluations and cadaver labs (see below) are important to track progressive independence and competency.

In addition to oncology procedures, the staff gynecologic oncologists at Mayo perform some complex benign surgery, so you are exposed to many different types of gynecologic procedures during your assignments. To ensure that you have the opportunity to gain superior surgical skills, you gain experience with:

  • Rectovaginal, vesicovaginal and colovaginal fistulas
  • Vaginal and perineal reconstructive procedures
  • Vaginal hysterectomies
  • Emergent cesarean hysterectomy for abnormal placentation (percreta)

Didactic training

You are required to complete the Master's of Biomedical Science degree program through Mayo Graduate School. Didactic courses in areas including biostatistics, cancer biology and pelvic anatomy are completed during the first year of training and are required for the fellowship. Courses in gross pelvic anatomy and upper abdominal anatomy are completed during the two clinical years. A written thesis and oral thesis defense along with a written examination are required to complete the master's program.

You attend one annual meeting of the Society of Gynecologic Oncology while you are in this training program and one meeting of the Gynecologic Oncology Group (GOG), a cooperative group. In addition, you attend other annual scientific meetings if you have an abstract or manuscript accepted for oral or poster presentation; we anticipate that most fellows will present research annually and encourage fellows to do so.

Unique training experiences

Cadaver lab

Virtual training

Consistent with our focus on surgical experience, we utilize several unique training formats to increase the surgical skills of our fellows. These include annual training in pelvic and upper abdominal anatomy and fresh (non-embalmed) procedure-based cadaver labs for our fellows. These consist of one-on-one dissection with the fellowship director and one other faculty member.

The first lab occurs just prior to entering clinical training and is focused on learning relevant anatomy and procedures. Subsequent labs (two or three) are designed to be evaluative labs where the fellow operates with one assistant and one scrub nurse to perform mock procedures relevant to complex gynecologic oncology surgery.

The fellow is independently evaluated by two faculty and given feedback and areas to focus on for improvement during the subsequent surgical rotations. Faculty and fellows find these incredibly helpful to assess training and help to identify areas of mastery and areas in need of additional cognitive or procedural development. It is anticipated that fellows will achieve mastery by the completion of the program.

Additionally, a robotic nerve-sparing hysterectomy lab is conducted using fresh cadaver for the fellows. This allows a detailed review of the procedure using videotapes and lecture culminating in a hands-on cadaver lab to allow the fellows to independently perform the procedure with faculty assistance.

All fellows complete a didactic and hands-on training program in both standard laparoscopy and robotic-assisted laparoscopy (including use of the virtual trainer) prior to beginning the clinical rotations.

Conferences

The complete conference, seminar and lecture schedule at Mayo Clinic includes approximately 100 presentations or discussions each week. While staff, fellows and residents are encouraged to attend as many of these as appropriate, it must be balanced with their commitments to course work, patient care, research, family life and outside interests.

You are required to attend these conferences:

  • Gynecologic Oncology Division Conference (weekly; September-June)
  • Department of Obstetrics and Gynecology Grand Rounds (weekly; September-June)
  • Gynecologic Oncology Clinical Meeting (weekly)
  • Gynecologic Oncology Fellowship Conference (weekly)

A recent addition to the weekly Gynecologic Oncology Division Conference is a Meet the Expert series. This occurs two or three times annually and is done using videoconferencing with an international expert in a selected topic. Recent faculty have included:

  • Carien L. Creutzberg, M.D., Leiden University Medical Center, Netherlands — The PORTEC Approach to Endometrial Cancer
  • Ate van der Zee, M.D., University Medical Center Groningen, Netherlands — Sentinel Lymph Nodes in Vulvar Cancer
  • Marie Plante, M.D., Centre Hospitalier Universitaire de Quebec, Canada — Fertility Sparing Surgery for Cervical Cancer
  • Riccardo Audisio, M.D., St. Helens Teaching Hospital, U.K. — Surgical Complications in the Elderly
  • Frederic Amant, M.D., University Hospitals Leuven, Belgium — Cancer in Pregnancy
  • Philipp Harter, M.D., Kliniken Essen-Mitte, Germany — Role of Lymphadenectomy in Advanced Ovarian Cancer

Finally, we have visiting experts in gynecologic oncology on a regular basis for named lectureships, Oncology Society Lectures and department grand rounds. Fellows are encouraged and provided time to interact with these national and international experts. Recent visitors have included:

  • Achim Schneider, M.D., Charité Campus Benjamin Franklin & Campus Mitte, Germany
  • Ronald Alvarez, M.D., University of Alabama at Birmingham
  • Ate van der Zee, M.D., University Medical Center Groningen, Netherlands
  • Javier F. Magrina, M.D., Mayo Clinic in Arizona

You present several formal lectures throughout the academic year to groups within the department and at interdepartmental meetings. For example, you make a quarterly presentation during Gynecologic Oncology Division Conference on a current, relevant topic in oncology. In addition, you are responsible for selecting timely cases and leading tumor board and morbidity and mortality (M&M) conferences that include representatives from gynecologic pathology, therapeutic radiology, medical oncology and gynecologic oncology.

You may receive requests from other departments to present lectures about pertinent issues in gynecologic oncology. You are encouraged to accept these invitations. Additionally, fellows have the opportunity to participate in didactic teaching for medical students and residents in obstetrics and gynecology.

Also see:

  • Jan 30, 2014
  • ART803658