Educational Objectives of the Program:

Following completion on the Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program at Loyola University Medical Center, the fellow must:

1. Demonstrate clinical competence in the evaluation and treatment of female pelvic floor disorders.

   1. Be able to provide consultation and comprehensive management of women with complete benign pelvic conditions, lower urinary tract disorders and pelvic floor dysfunction.

2. Master the knowledge and skills to work as a consultant to other physicians.

3. Display understanding and experience with the scientific method of hypothesis generation and testing and have demonstrated this by participation in several clinical, translational and/or basic science research projects.

4. Master the educational techniques for teaching of medical students, residents and peers.

5. Attain the skills necessary for achieving excellence in an academic environment.

6. Obtain the basic understanding of the physician’s role in a healthcare organization, the cost-effectiveness of patient care and the means by which improvements/changes in the healthcare institutions can be achieved.

Clinical
We offer our patients a multidisciplinary approach to the evaluation and treatment of pelvic floor disorders in a newly constructed, state-of-the-art ambulatory center. Fellows are assigned to a single FPMRS attending for a three month block of time to enhance continuity of care.  This provides fellows the opportunity to participate in initial patient consultation and evaluation; treatment (including surgical); as well as in- and out-patient follow-up. The fellow assigned to a particular service is responsible for working with the attending, residents, and medical students to ensure efficient clinical/office flow, preparing patients for surgery, and overseeing patients’ care in the hospital after surgery.  Fellows interact regularly with other pelvic floor subspecialists, including urologists, colorectal surgeons, physical therapists, and gastroenterologists.  One half day per week, a gastroenterologist, Dr Angie Losavio, sees patients in the Urogynecology outpatient center.  A FPMRS fellow works with Dr Losavio on those mornings. 

Fellows develop clinical expertise in diagnostic and operative office endourology (cystoscopy, intravesical injection, and stent removal), urodynamic testing, neurophysiologic testing of the pelvic floor, including electromyography and sensory nerve testing, and pelvic floor ultrasound.Our surgical practice is diverse, including a variety of procedures for urinary incontinence, pelvic organ prolapse, and fecal incontinence; complex fistulas; vaginal reconstruction; continent and incontinent urinary diversions; resection of bladder tumors; and endourologic procedures. Our fellows are well-trained in abdominal, vaginal, laparoscopic and robotic pelvic reconstructive surgery.

Fellow’s schedules are planned to enhance balanced research, scholarship, and clinical care.  Fellows are prohibited from participating in non-emergent clinical care during research and academic time.  Over the 10-years we have been at Loyola, this balance is well-established, and although, flexibility is necessary due to vacation and personal issues, the balance is working well for our fellow’s education. 

Education
The Loyola program is structured to emphasize fellow education well beyond the normal clinical contact hours.  Wednesday’s are devoted to departmental and FPMRS divisional scholarly conferences.  Wednesday mornings from 7:30-9:30, Urology and Obstetrics & Gynecology hold departmental educational conferences.   The urology department also holds conferences on Friday mornings from 7:00 to 9:00. FPMRS faculty, and the fellow on their service, attends conferences of the faculty’s primary department. These conferences cover a variety of topics including informal seminars, clinico-pathologic conferences, morbidity/mortality conferences and journal clubs. 

 Wednesday afternoons from 2:30-5:30, all FPMRS faculty and fellows attend FPMRS divisional conferences.  This three hour block of time is protected and mandatory for both the faculty and fellows, demonstrating the high value all FPMRS faculty place on scholarship.  During these conferences, Research Conference, Case Conference and the FPRMS Conference, we cover the FPMRS learning objectives as well as different aspects of the FPMRS curriculum.

The Research Conference is comprised of all involved FPRMS faculty, fellows, residents, and staff involved in research activities, including research coordinators, data manager, and grant’s administrator.  We review on-going trials and new study concepts from fellows and faculty and update the group regarding NIH Urinary Incontinence Treatment Network and Pelvic Floor Disorders Network activities. Fellows learn about all aspects of research including study design, implementation, recruitment and retention strategies, data collection and management, and data analysis and dissemination.  This unique, regularly scheduled interdisciplinary research conference also teaches fellows the importance of teamwork and continued oversight for successful research. 

The Case Conference includes FPMRS faculty, fellows, residents, and medical students as well as physical therapists, urologists, physiatrists, and gastroenterologists.  During this conference, we formally present all surgical cases for the following week in addition to other “interesting”, multidisciplinary cases.  This aspect of our curriculum includes discussion of the evaluation and management of pelvic floor disorders; however, it is also where we address peri-operative management of medical co-morbidities and risk factors such as deep vein thrombosis prophylaxis, bowel preparation, cardiac risk factors, etc.  We use this opportunity to review the current literature on these topics. 

The FPMRS Conference is a didactic/problem-based learning session. The content and format of this conference varies. Fellows and residents are assigned topics selected from the 2003 “Guide to Learning in Female Pelvic Medicine & Reconstructive Surgery” sponsored by ABOG and ABU.  This aspect of our curriculum covers each of the listed learning objectives every two years.  Fellows also learn to evaluate the literature, prepare seminars, and practice their oral presentation skills.  Additionally, colleagues from other disciplines and the basic sciences regularly present their research during this conference.   Faculty lead round table discussions on historic and current topics in FPMRS.  We also separately cover issues of practice based medicine and coding during FPMRS Conference; although, these are routinely coverer during the fellow’s clinical education as well.

We also meet every Monday morning as a group from 7-7:30am.  Monday morning conferences include Journal Club alternating weekly with formal curricula in urodynamic and neurophysiologic testing and biomedical writing.

Loyola offers two degree seeking graduate programs for fellows. Interested fellows are encouraged to obtain a (1) Master of Arts in Bioethics; or (2) Master of Science Degree in Clinical Research Methods during their fellowship. Fellows not enrolled in a MS degree program are required by ABOG/ABU guidelines to complete two university graduate level courses; one in quantitative techniques, such as biostatistics and the other in something relevant and of interest to the fellow.

Believing that fellow education is paramount, all faculty have dedicated weekly academic time to meet fellows for one-and-one mentoring at the fellow’s discretion. We also believe adult education should be tailored to the individual’s goals and allow off-site and overseas electives when appropriate.

Research
Research continues to be a major emphasis and strength of Loyola’s FPMRS fellowship program.  Understanding that the demands of clinical/surgical practice after graduation are sometimes perceived as barriers to the timely and successful progression as independent primary investigators by well-trained Obstetrics & Gynecology and Urology fellows, we believe that training clinician-scientists, particularly in surgical specialties, is a creditable goal and that fundamental to this training is teaching fellows how to make research an integral part of their daily professional lives.  A fundamental philosophy and unique strength of our training program is that our fellows actively engage in dedicated clinical and translational research training, where they participate in on-going comparative effectiveness trials, recruitment and retention of research subjects, and development and implementation of independent clinical and translational studies during their entire three years of fellowship.  We believe research and research training should be a part of all aspects fellowship training and that integration of research and clinical care is a learned skill.  We actively teach how to accomplish important research goals and become independent primary investigators after graduation WHILE still maintaining surgical practices; in life, these activities occur concurrently not in sequence, so to be successful, clinical-scientists must learn to integrate these skills.  We also recognize that demands of clinical practice often preclude active involvement of clinical faculty themselves in basic science research.  Therefore, it is essential for FPMRS fellows to learn to dialogue, respect, and collaborate with basic science investigators.

Our fellowship is housed in an active clinical research unit where FPMRS faculty are all clinician-scientists with advanced degrees in clinical research and statistical analysis in addition to fellowship training in pelvic surgery.  We also have a well-established interdisciplinary team of investigators (clinician-scientists and basic scientists) who meet regularly to brainstorm and develop innovative, collaborative methods to bring ideas from bedside to bench back to bedside.  These types of interactions and relationships, which are well established in our program, teach FPMRS fellows to (1) “speak the same language” as basic scientists; (2) respect the talents and skills necessary to do basic research; and (3) apply these skills to problem solving in clinical medicine through translational research.  This model allows them to develop similar collaborative relationships after graduation.  In addition, twice yearly, we have an offsite fellow’s research retreat. During this time, faculty and fellows come together in a relaxed environment over wine and cheese to brainstorm about improving care for our patients through research.

To prepare for academic careers as independent clinical scientists in women’s health care and pelvic floor disorders, we require FPMRS fellows to acquire the following clinical research skills:

• Ability to critically analyze and review the literature.

• Ability to develop testable hypotheses.

• Ability to design clinical trials to test scientific hypotheses and treatment outcomes.

• Ability to write competitive research proposals and grants.

• Ability to disseminate scientific results in both written and oral forms.

• Understanding of interdisciplinary approaches to research in pelvic floor disorders. 

Additionally, as evidence of their mastery of clinical research and potential to become independent clinician scientists, they are required to do the following prior to completion of the program:

• Obtain a Master’s degree in Clinical Research if they do not already have advance clinical research or epidemiology training.

• Prepare a NIH grant proposal, which they will have when they start their academic careers.

• Prepare and defend a written thesis.

The research training program is designed to provide each fellow with the mentorship, opportunities, and time to achieve each of the listed items.  The current design of our research curriculum enables fellows to start independent projects during their first months of fellowship.  We encourage fellows to design and complete a retrospective case-series or case-control study in their first three to four months.  In addition, to preparing a proposal and submitting it to the IRB, this quickly introduces new fellows to setting up and managing an SPSS database and preparing an abstract for submission.  Equally importantly, it gets them excited about research early in their fellowship.  The four most recent fellows successfully completed and presented projects at national meetings during their first year; all lead to peer-reviewed publications as well.  Fellows continue to develop more advanced hypotheses and design prospective studies during the three years.  We support and expect fellows to lead and participate in multiple high-quality research studies that result in publication.  Part of the research curriculum includes a step-wise approach to concept development.  They also have the opportunity to spend dedicated time in a basic science laboratory or develop translational projects with the help of basic science faculty. 

Scientific meetings

We fully support and encourage the fellows to present and participate at national and international conferences, such as the American Urogynecologic Society, the American College of Obstetricians and Gynecologists, the American Urological Association, the Society of Gynecologic Surgeons, the Society of Urodynamics and Female Urology, the North Central Association of the AUA and the International Continence Society meeting.  The fellows are expected to attend, at a minimum, the American Urogynecologic Society annual meeting. Other scientific meetings may also be selected with the approval of the fellowship director. 

Updated:  08/09