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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:
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Demonstrate clinical
competence in the evaluation and treatment of female pelvic floor
disorders.
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Be able to
provide consultation and comprehensive management of women with
complete benign pelvic conditions, lower urinary tract disorders
and pelvic floor dysfunction.
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Master the knowledge
and skills to work as a consultant to other physicians.
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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.
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Master the
educational techniques for teaching of medical students, residents
and peers.
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Attain the skills
necessary for achieving excellence in an academic environment.
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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:
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Ability to critically analyze and review the literature.
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Ability to develop testable hypotheses.
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Ability to design clinical trials to test scientific hypotheses and
treatment outcomes.
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Ability to write competitive research proposals and grants.
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Ability to disseminate scientific results in both written and oral
forms.
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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:
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Obtain a Master’s degree in Clinical Research if they do not already
have advance clinical research or epidemiology training.
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Prepare a NIH grant proposal, which they will have when they start
their academic careers.
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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 |