Fellowship Program in Female Pelvic Medicine & Reconstructive Surgery
University of Texas Southwestern Medical Center
Dallas, Texas

Summary description of fellowship program:

This fellowship in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) is a 3-year program designed to train obstetrician/gynecologists or urologists for productive careers in academic medicine. Sponsored by the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, the program uses the teaching facilities of the University of Texas Southwestern Medical Center in Dallas, Texas. Currently this program is approved to accept 1 fellow per year, for a total of 3 fellows. Two years of the fellowship are devoted to clinical training at Parkland Memorial Hospital, St. Paul Medical Center, Zale Lipshy University Hospital, and the James W. Aston Ambulatory Center. One year of the fellowship is devoted to acquiring basic science research skills within the Department of Obstetrics and Gynecology.

This fellowship program was first accredited by the American Board of Obstetrics & Gynecology in August 1999 and re-accredited for 4 years in July 2001.

Mission of department:

The Department of Obstetrics and Gynecology is strongly committed to education, research, and clinical practice. Although academically oriented, the department has also been rated as one of the top 10 clinical departments in the country for many years.

Faculty members in all divisions are nationally known academicians and leaders in obstetrics and gynecology. Our department chairman, Dr. Steven L. Bloom, serves as an author of Williams' Obstetrics.  Dr. Norman Gant, former department chairman, currently is the executive director of the American Board of Obstetrics and Gynecology located in Dallas.   Dr. Gant has been a driving force behind the development of urogynecology as a subspecialty.

Subspecialty training is a primary emphasis of the department. For many years, programs in maternal-fetal medicine, in reproductive endocrinology and infertility, and in gynecologic oncology have been thriving within an extremely supportive environment.

We strive to train fellows who will become future leaders in urogynecology. As such, our goal is to provide a well-rounded education in clinical urogynecology. In addition, we aim to mentor future researchers. Every effort is made to provide research training and to develop skills necessary for a research career.  The department also believes that all fellows should be excellent teachers. Fellow are expected to devote time and effort toward the education of residents and medical students.

History of division and fellowship program:

The Division of Urogynecology and Reconstructive Pelvic Surgery was established by Dr. Schaffer in July 1997. The clinical practice and research program grew rapidly allowing for the start of our fellowship program in July 1999.

Faculty:

Joseph Schaffer, MD (Urogynecology - Program Director)
Marlene Corton, MD (Urogynecology)
Clifford Wai, MD
Larry Word, MD (Urogynecology)
Ann Word, MD (Basic Science Research)
Bob Shull, MD (Urogynecology - Scott & White Clinic)
Kim Coates, MD (Urogynecology - Scott & White Clinic)
Phillipe Zimmern, MD (Urology)
Kenneth Leveno, MD (Clinical Research)
Clifford Simmang, MD (Colorectal Surgery)
Sharon Gregorcyzk, MD (Colorectal Surgery)
Randy Krim, MD (Colorectal Surgery)
Donald McIntire, PhD (Biostatistics)

Current Fellows

Shayzreen Roshanravan, MD
Amanda Bona White, MD

The Match:

The FPMRS program at UT Southwestern will be participating in the NRMP fellowship match and accepting 1 fellow to begin in July 2004.

Sample Fellowship Schedule

Park = Parkland, Priv = private service, S&W = Scott & White, Res = Basic Science Research

Currently the first and third years of the fellowship program are spent in clinical activities and the second year of the program is spent in basic science research under the supervision of Dr. Ann Word.

The clinical urogynecology service is comprised of the Parkland Memorial Hospital (Parkland) service and the private service. Fellows rotate in 3-month blocks between the Parkland service and the private service.  Both clinical fellows attend the Parkland urogynecology clinic on Thursday. The Parkland fellow attends the Parkland pre-op clinic on Tuesday morning. The private fellow attends the private clinics on Tuesday and Wednesday mornings. The research fellow attends the research clinic on Monday.

During the first year of the fellowship program, one month will be spent working with Drs. Bob Shull and Kim Coates at the Scott & White Clinic in Temple, Texas. The Scott & White Clinic is located about a 2 ½-hours drive from Dallas. The department will arrange for housing during the time fellows are working at Scott & White Clinic. Dr. Shull is an expert vaginal surgeon, and this experience is expected to contribute significantly to fellowship training.

During the months when one clinical fellow is participating in an outside rotation, the remaining fellow will cover both the Parkland and private services and will attend Parkland and private clinics.

During the third year of training, fellows spend a one month rotation on the urology service and one month working with the colorectal surgery service.  An elective month that the fellows must organize allows additional learning in an area of their own interest. The rotation must be approved in advance by the fellowship director.
Responsibility and autonomy increase during the 3-year fellowship program. These culminate when the fellow serves as a junior attending during the final 2 months of the fellowship.

Conferences:

The division has an active conference schedule in which all fellows (clinical and research) participate:

     Tues 0730-0830 (1st and 3rd Tues)  Fellows meeting with Dr. Schaffer
         Meeting to discuss any clinical issues or other areas of concern to the fellows

     Wed 1100-1200  Gynecology Grand Rounds
         Departmental grand rounds. Fellows are encouraged to attend when they are available.
         The Parkland  clinical fellow and the research fellow may be free to attend; however, the 
         private fellow generally will not be free to attend. Each fellow presents a lecture for
         grand rounds once a year.
 
     Wed 1300-1400  Private Practice Chart Review
         Interesting cases from the week's private practice clinics are discussed. The fellow picks
         the cases.

     Wed 1400-1500 (1st Weds)  Physical Therapy Conference
         Biofeedback and physical therapy cases are presented by the nurse practitioners and
         physical therapists.

     Wed 1500-1600  Parkland Pre-op Conference
         All Parkland surgical cases for the upcoming week are presented by the fellow and
         the residents.  Patients coming in for pre-op evaluation the following week are also
         discussed. The fellow is responsible for organizing this conference, supervising the
         residents, and collecting the pertinent data (eg, charts, x- rays).

     Wed 1600-1700 Chapter Review (with Department of Urology)
         Each week a chapter is reviewed from a urogynecology book (alternating on a yearly 
         basis between Ostergard's text and Walter's text). The chapters are presented by the
         fellows and the residents. The presenter prepares an outline for the rest of the group.
         Urology faculty and fellows attend this meeting.  Once every two months is a joint 
         Urogynecology/Urology journal club.

     Thurs 0730-0830 (1st Thurs)  Journal Club
         The purpose of journal club is to review the current literature from the major journals
         in our field. The research fellow is responsible to pick the articles (with input from 
         faculty or other fellows), assign people to review and present, and distribute the
         articles several weeks in advance to all the attendees. Generally, three articles are
         reviewed, one by a fellow and two by residents. Articles are presented using a standard
         format for article review that will be provided by the program director.
 
     Thurs (2nd Thurs)   Basic Science Works in Progress
         The research fellow presents the results of ongoing research in the lab. The meeting
          is supervised by Dr. Ann Word.

     Thurs (3rd and 4th Thurs) Clinical Research Conference
         Clinical research is discussed with an emphasis on current and future projects. Planning
         for abstract and journal submission occurs at these meetings.

Research:

A primary goal of the fellowship program is the training of productive researchers. Supported by the department and division, fellows are expected to become involved in research from the start of the fellowship and to continue this involvement throughout the 3-year program. Fellows are expected to present abstracts at national meetings and produce manuscripts for publication each year of the fellowship program.

Areas of research interest within the division include: childbirth related pelvic floor injury, pathophysiology of prolapse and incontinence, outcome of treatments for urinary incontinence, and anatomy of the pelvic floor. Multiple research opportunities exist for fellows, and research mentoring is a priority of the faculty.
Currently, the division has 2 NIH grants, one investigating childbirth-related pelvic floor injury and the other evaluating urinary incontinence treatment.

During the first year of the fellowship, the fellow should meet with Dr. Ann Word on a regular basis to develop ideas that can be pursued during the fellowship's second year, which is devoted to basic science research. The fellow spends the entire second year in the research lab, but is also encouraged to continue clinical research pursuits.

Residents:

UT Southwestern has the largest Ob/Gyn residency in the country with 16 residents per year. In addition, St. Paul Medical Center (part of UT Southwestern) has its own Ob/Gyn residency program which is run by our department. The St. Paul program has 3 residents per year. Our division is responsible for providing basic urogynecology training for the residents of both programs. Residents rotate for 2 months on the urogynecology service. Currently, 3 to 5 residents rotate per month on our service. The department has a strong commitment to resident education, and fellows are expected to be effective teachers and supervisors. The Parkland clinical fellow is the direct supervisor of all the residents on the clinical service.

Rounding and Beeper Policy:

The urogynecology service team members round each morning prior to the start of surgery and clinic work. Students and residents are supervised by the urogynecology fellow. Fellows are expected to see all patients and direct their care. A clinical note written by the fellow is expected each morning on all in-patient charts. Attending rounds are at the discretion of the faculty member on service.

The two clinical fellows divide the weekend rounds so that each fellow rounds every other weekend.
Fellows are available for beeper call on their services at all times.

Anatomy Lab:
  
We have an anatomy dissection laboratory under the direction of Dr. Marlene Corton. Clinical fellows spend each Tuesday afternoon in the lab dissecting and teaching residents.

SCMIS:

Located on the UT campus, the Southwestern Center for Minimally Invasive Surgery is a comprehensive educational, clinical, and research facility that is dedicated to advancing minimally invasive surgery. Opportunities are available for fellows with interest in minimally invasive surgery.

Statistics:

Fellow Cases 7/1/01 - 6/30/02 (compiled from the ABOG annual report)

Urodynamics 472
Cystoscopy 219
Burch 51
Slings 67
LPY Burch 19
Collagen 11
Abdominal Prolapse Procedures 172
Vaginal Prolapse Procedures 100
Laparoscopic Prolapse Procedures 27

Outside rotations:

Scott & White - 2 months
Urology - 1 month
Colorectal - 1 month
Elective - 1 month

CME:

Each fellow is funded to attend the AUGS and SGS annual conferences each year. Fellows are expected to attend the full conference. Fellows are encouraged to present their work annually at these conferences. Other conferences may also be funded at the discretion of the program director, particularly if research is being presented.

Each August the division sponsors a CME course in urogynecology which all fellows are required to attend.

Texas Medical License:

Application for a Texas medical license should be instituted immediately after a fellow is accepted into the program.  The licensing process in Texas is cumbersome and time consuming.  If not begun well in advance, obtaining a license prior to the beginning of the program will be difficult.  The Texas Medical Board (TMB) accepts applications on line.  Their web site is http://www.tmb.state.tx.us/.  For more information, please see Getting Your Texas Medical License.

Personal Time Off:

Personal time off must be approved by the program director and coverage by other clinical fellows must be obtained.  For department guidelines, please see the Personal Time Off section of Fellowships in Obstetrics and Gynecology.

Compensation and Benefits:

Please see the Compensation and Benefits section of Fellowships in Obstetrics and Gynecology.

Clinical Service Opportunities Outside Female Pelvic Medicine & Reconstructive Surgery:

Off-service fellows have the option of taking in-house night call on the Ob/Gyn service at University Hospital - St. Paul.  This clinical service is not associated with the fellowship training program.  A permanent Texas Medical License is required to participate.  See also the Compensation and Benefits section of Fellowships in Obstetrics and Gynecology.

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