Matching Trends for the Fellowship in Minimally Invasive Gynecologic Surgery Since Participation in the National Residency Match Program

Objective

To evaluate the level of interest in the fellowship in minimally invasive gynecologic surgery (FMIGS) using data from the National Residency Match Program (NRMP) over the past 5 years.

How to organize gynecologic oncology in the future: Results of an internationalquestionnaire

Vergote IB, de Oliveira CF, Dargent D. How to organize gynecologic oncologyin the future: Results of an international questionnaire. Int J GynecolCancer 1997; 7: 368–375.
A questionnaire was sent to 93 gynecologic oncologists from 54 countriesabout the way in which gynecologic oncology was organized in their country, orif the (sub)speciality wasnot yet recognized, how they thought it should be organized. The questionnairewas answered by 64 persons from 42 different countries. The subspecialty wasrecognised in 17 (41%) of the countries. Fifty-five respondents (86%) thought thatgynecologic oncology should be a subspecialty of obstetrics and gynecology. Themedian duration of the gynecologiconcologic fellowship program was 30 months. Diagnosis and surgery accounted forabout 58% of the duration of the program. In 52% of the answersfrom countries with boardcertification, the fellows had to pass a theoretical and practical examination,and in addition 22% of the candidates had to defend a thesis to qualifyfor certification.Training centers in countries that recognized gynecologic oncology had amedian number of 142 new cases per year (for 1 fellow). The median number ofgynecologic oncologogistsand fellows per 10⁽⁷⁾ inhabitants in countries with boardcertification in gynecologic oncology was 42 and 6, respectively. Finally, theimportant role of internationalsocieties (like the International Gynecologic Cancer Society and the EuropeanSociety of Gynaecological Oncology) in supporting the countries withoutrecognized GynecologicOncology was stressed by the respondents. The setting up of internationalstandards for training programs, training centers, board certification, and theorganization ofinternational exchange programs for fellows seemed to be equally important,according to the questionnaire responses.     

Does a minimally invasive surgery fellowship impact surgical experience among gynecology residents?

STUDY OBJECTIVE: To examine the impact of a minimally invasive surgery (MIS) fellowship on resident experience and to survey the general attitude toward effects of fellowship programs on resident education. DESIGN: Survey (Canadian Task Force classification III). SETTING: An accredited obstetrics and gynecology program in the United States. SUBJECTS: Obstetrics and gynecology residents. INTERVENTION: Residents received a survey regarding the potential impact of a MIS surgery fellowship on resident experience. MEASUREMENTS AND MAIN RESULTS: One year after creation of a MIS fellowship at our institution, we conducted an anonymous survey among residents. We also compared total number of surgical procedures and laparoscopic procedures performed before and after the fellowship commenced. We had a response rate of 70%. The overall impact of the newly established fellowship was regarded as positive. The median approval rating of endoscopic training before and after institution of the fellowship was 3.0 and 4.0, respectively (p < .001). There were no statistically significant changes in caseload between the two periods. CONCLUSION: A fellowship in MIS at an academic institution does not detract from resident experience in gynecologic surgery, with most residents viewing the fellowship positively.     

Factors affecting fellowship satisfaction among gynecologic oncology fellows

OBJECTIVE: The objective of this study was to determine fellowship satisfaction through a survey of gynecologic oncology fellows. METHODS: A survey was sent to all gynecologic oncology fellows in May 1998. Surveys were returned anonymously and confidentially. The questions focused on demographics, research and clinical experience, education, faculty involvement, future plans, and fellowship satisfaction. Association between variables were studied using chi(2) and two-tailed t tests. RESULTS: Of the surveys 53.8% were returned. Reputation, faculty, and clinical diversity were ranked the top three reasons for choosing a fellowship program. Eighty-seven and three-tenths percent were satisfied and 89.1% would recommend their fellowship. Fellows listed the two areas they were most satisfied with as surgical training and research support. Seventy-nine and four-tenths percent agreed they spent adequate time in the operating room and 94.1% had enough variety. Sixty percent or more of the clinical fellows felt they would be uncomfortable performing vaginal radical hysterectomies, splenectomies, radical vaginectomies, laparoscopic lymph node dissection (LND), scalene LND, skin grafts, creation of neovagina, tram flaps, and ureterovaginal fistula repairs by the end of their fellowship. Of the fellows surveyed, 94.7% were currently performing research. All believed they would finish their thesis by the end of their training. Thirty percent of fellows from Gynecologic Oncology Group institutions were not required to participate in their research trials. Among the clinical fellows 62.2% thought time for self-education was lacking compared with 35.3% of the research fellows, P = 0.07. The two areas fellows were least satisfied with were didactics and lack of time for other pursuits. Performance evaluations were received by 72.2%; however, evaluations of the program and of the attending staff occurred in only 51.3 and 34.0%, respectively. Sixty-seven and three-tenths percent stated they had a mentor and 34.0% an advisor. Fellows that did not have mentors or advisors thought they spent less time with faculty in educational pursuits (P = 0.03, 0.06). CONCLUSION: Areas that could improve fellowship satisfaction include formal didactics and time for self-education. Evaluations of the fellowship and faculty could provide a forum to continue to assess their needs. Requiring a more active role of fellows in research trials may prove to increase research productivity in the future.     

Laparoscopy training in gynecologic oncology fellowship programs

ObjectiveTo assess the adequacy of laparoscopic surgical training as perceived by gynecologic oncology fellows-in-training and to compare current opinions to those on a 2003 survey.Study designFellows were surveyed via mail or an internet website.ResultsSeventy-eight (64%) of 121 fellows responded. One-hundred percent now state that laparoscopy is important or very important in gynecologic oncology practice compared to 86% in 2003. Ninety-five percent reported that much or maximum emphasis should be placed on laparoscopic training compared to 70% previously. Currently, 69% believe that their fellowship training in laparoscopy is very good or good compared to only 25% who felt this way 4 years ago. Importantly, fellows now believe they are getting better laparoscopic training in fellowship than they did in residency. Seventy-eight percent stated that their perceived laparoscopic skills were good or very good. Upon completion of fellowship, 94% plan to perform ≥ 6 cases per month laparoscopically.ConclusionsRespondents believe that laparoscopic training should be emphasized in fellowship training and perceive their laparoscopic training to be significantly improved compared to 2003. They also envision a key role for laparoscopy in their future practice.     

Abortion training in Canadian obstetrics and gynecology residency programs

OBJECTIVE: To study abortion training in Canadian obstetrics and gynecology (ob-gyn) residency programs. METHODS: An anonymous questionnaire was sent to all postgraduate year (PGY)-4 and PGY-5 ob-gyn residents (n=130) and residency program directors (n=16) in Canada. The questionnaires inquired about demographic information, details of abortion training, resident participation in training, and intention to provide abortions after residency. RESULTS: Ninety-two of 130 residents (71%) and 15 of 16 program directors (94%) responded. Abortion training is considered routine in approximately half of programs and elective in half. The majority of residents (71%) participated in abortion training, and half plan to do elective abortions after residency. More than half of residents felt competent after training to perform first-trimester aspiration and second-trimester inductions but did not feel competent in first-trimester medical abortions or dilation and evacuation (D&E). Residents were more likely to participate in training if the program arranged the training for residents (P=.04) and were more likely to intend to provide abortions if the training was considered routine (P=.02), while controlling for all significant demographic and training variables. CONCLUSION: Most Canadian ob-gyn programs offer some training in elective abortion, but only half include it routinely in training, and the minority of residents feels competent in D&E and medical abortion. Integrated abortion training was associated with greater resident participation in training and increased likelihood of intention to provide abortions after residency.     

Society of Gynecologic Oncology recommendations for fellowship education during the COVID-19 pandemic and beyond: Innovating programs to optimize trainee success

In approximately ten months' time, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected over 34 million people and caused over one million deaths worldwide. The impact of this virus on our health, relationships, and careers is difficult to overstate. As the economic realities for academic medical centers come into focus, we must recommit to our core missions of patient care, education, and research. Fellowship education programs in gynecologic oncology have quickly adapted to the “new normal” of social distancing using video conferencing platforms to continue clinical and didactic teaching. United in a time of crisis, we have embraced systemic change by developing and delivering collaborative educational content, overcoming the limitations imposed by institutional silos. Additional innovations are needed in order to overcome the losses in program surgical volume and research opportunities. With the end of the viral pandemic nowhere in sight, program directors can rethink how education is best delivered and potentially overhaul aspects of fellowship curriculum and content. Similarly, restrictions on travel and the need for social distancing has transformed the 2020 fellowship interview season from an in-person to a virtual experience. During this time of unprecedented and rapid change, program directors should be particularly mindful of the needs and health of their trainees and consider tailoring their educational experiences accordingly.     

Clinical activities of gynecologic oncologists: Results of a survey

A questionnaire was designed to survey gynecologic oncologists. The survey obtained basic identifying information, a profile of their individual clinical practice including a measurement of their involvement in clinical activities of other surgical and medical specialities, their interrelationships with these other specialists, the number and distribution of their scientific publications, and the extent of their commitment to teaching and to the use of paramedical personnel. The questionnaire was answered by 95.5% (128 of 134) of the members of the Society of Gynecologic Oncologists (group 1) and by 82% (114 of 139) of all non-SGO members who had completed approved fellowship training in gynecologic oncology (group 2). It was felt that these two groups include the vast majority of physicians in America devoting the bulk of their professional time to gynecologic oncology. A “state of the art” was sought. The results of the survey of these two groups are presented and discussed.     

A retrospective study evaluating the impact of formal laparoscopic training on patient outcomes in a residency program

STUDY OBJECTIVE: To evaluate the impact of a formal laparoscopic training program on patient outcomes in an obstetrics and gynecology residency. DESIGN: Retrospective cohort study (Canadian Task Force classification II-1). SETTING: University-affiliated public hospital. INTERVENTION: Comparison of nonlaparoscopy-trained group (A) with a formally trained group (B). SUBJECTS: Three hundred sixty-eight women (group A) and 154 women (group B) undergoing operative laparoscopy. MEASUREMENTS AND MAIN RESULTS: Beginning October 1, 1999, residents, regardless of postgraduate year status, participated in six 4-hour sessions/year in a committed laparoscopic training program consisting of didactics, bench exercises (designed to mimic laparoscopic gynecologic technical skills), instrumentation instruction, animate tissue model surgery, and supervised gynecologic operating experience. Two certified gynecology laparoscopists facilitated each training session, and gynecologists with various laparoscopic skill levels supervised patient surgeries. Operating room time, blood loss, hospital stay, and conversion to laparotomy were less for group B than for group A, but the groups did not differ in complication rates. Adhesions and bleeding were the main reasons for conversion to laparotomy. CONCLUSION: Formal laparoscopic training of gynecologic residents improved patient outcomes.     

Underrepresented minority representation trends in gynecologic oncology fellowships in the United States

ObjectiveTo evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME).MethodsData on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups.ResultsA total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties.ConclusionsThis study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.     

The maternal-fetal medicine fellowship match system: effectiveness at identifying successful clinician-investigators at 1 institution

OBJECTIVE: To determine if rank position on the match list of a maternal-fetal medicine (MFM) fellowship program predicted applicant academic success. STUDY DESIGN: The Thomas Jefferson University MFM fellowship program rank order lists and the results of the match were reviewed for 1991-2002. Evaluation of candidates includes an application, 3 letters of recommendation, curriculum vitae and interview upon invitation. Career success of graduated fellows was defined as MFM board certification, number of peer-reviewed publications and of Society for MFM (SMFM) abstract publications. RESULTS: Applicants ranked higher tended to have more peer-reviewed publications per applicant (9.2 vs. 4.7 vs. 4.4, p = 0.5) and more abstracts presented at SMFM (7.6 vs. 8.0 vs. 3.8 p = 0.5) as compared to lower-ranked applicants. Ranked applicants had a higher probability of being MFM board certified (74 vs. 22%, p = 0.005), having more peer-reviewed publications (6.8 vs. 1.4, p = 0.005), and more abstracts (7.1 vs. 2.1, p < 0.0001) as compared to nonranked applicants. CONCLUSION: MFM fellowship applicants who were ranked higher were more likely to publish as compared to lower-ranked applicants. Ranked applicants were more likely to publish and be MFM board certified as compared to nonranked applicants.     

A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29-78 years). The mean pelvic lymph node count was 31 (range, 10-61) in the TLRH group versus 21.8 (range, 8-42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100-600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200-464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2-11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.     

Are newborns receiving premedication before elective intubation?

AIMS: To determine the extent and type of premedication used for elective endotracheal intubation in neonatal intensive care units (NICUs). METHODS: A pretested questionnaire was distributed via e-mail to the program directors of the neonatology divisions with accredited fellowship programs in Neonatal-Perinatal Medicine in the United States. RESULTS: Of the 100 individuals contacted, 78 (78%) participated in the survey. Only 34 of the 78 respondents (43.6%) always use any premedication for elective intubation. Nineteen respondents (24.4%) reported to have a written policy regarding premedication. Morphine or fentanyl was used most commonly (57.1%), with a combination of opioids and midazolam or other benzodiazepines used less frequently. Fourteen respondents (25%) also use muscle relaxants with sedation for premedication, but only nine respondents combined paralysis with atropine and sedation. CONCLUSION: Most neonatology fellowship program directors do not report always using premedication for newborns before elective endotracheal intubation despite strong evidence of physiologic and practical benefits. Only a minority of the NICUs has written guidelines for sedation, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.     

Graduating Obstetrics and Gynaecology Residents’ Readiness for Practice: A Cross-Sectional Survey Study

ObjectiveThis study sought to evaluate the self-reported and program director–reported comfort of graduating Canadian obstetrics and gynaecology residents in independently performing various surgical skills.MethodsA Web-based survey was distributed to four cohorts of graduating obstetrics and gynaecology residents across Canada (2014-2017). Residents were asked to indicate their comfort level with independently performing 34 core surgical procedures by using a five-point Likert-type scale. A similar survey was sent to program directors. Comfort scores for residents and program directors were compared using quantitative and qualitative methods as appropriate (Canadian Task Force Classification II-3).ResultsResident and program director survey response rates were 168 of 320 (52.5%) and 20 of 48 (41.7%), respectively. Residents were “comfortable” or “very comfortable” performing 7 of 13 (54%) gynaecology and 4 of 6 (67%) obstetrics List A procedures independently. Program directors reported that residents were “comfortable” or “very comfortable” performing 10 of 13 (77%) gynaecology and 4 of 6 (67%) obstetrics List A procedures. Compared with program directors, residents reported lower comfort with certain minimally invasive and obstetrics List A procedures (P < 0.05). Differences in comfort when performing several List A procedures were related to training program size and plans to pursue fellowship. Qualitative analysis revealed several major and minor themes supporting the dichotomy between residents’ lack of comfort and program directors’ expectation of comfort.ConclusionGraduating residents were not comfortable performing many core surgical procedures independently. Additionally, program directors believed that trainees were more comfortable than they reported, and comfort varied according to program size and future fellowship plans. The new competency-based curriculum is an opportunity to address this gap.     

Obstetrics and gynecology residents' attitudes toward maternal-fetal medicine fellowship training.

OBJECTIVE: To assess factors associated with residents' decisions to pursue or forego fellowship training in maternal-fetal medicine (MFM). METHODS: A survey utilizing multiple-choice, Likert, ordinal and categorical scale questions was distributed to all (n = 2337) postgraduate year (PGY) 3 and 4 obstetrics and gynecology residents in accredited US training programs during the 2001-02 academic year. The 18-question survey sought demographic and residency training details, quality of interactions with the MFM faculty and fellows, and information about 13 specific factors that might influence a resident's decision to pursue MFM training. RESULTS: Surveys were returned by 642 (27%) residents, equally divided between PGY 3 and 4. Only 90 (14%) residents reported either ongoing consideration of, or having already applied for, MFM training (MFM group), while 278 (43%) had considered MFM training, but chose to either stay in general practice or pursue another fellowship (neutral group). The remaining 274 (43%) reported never having considered MFM (never group). The three groups were similar with regard to demographic characteristics and residency training; however, the MFM group ranked the quality of teaching by the MFM faculty significantly higher than the neutral and never groups. Encouragement by the MFM faculty, salary during fellowship and the 3-year (as opposed to 2-year) duration were reported to be the strongest influencing factors and were significantly different from ten other factors considered in the survey (p < 0.05). CONCLUSION: Major positive factors influencing the pursuit of MFM training are the quality of educational experiences and encouragement from the MFM faculty. Conversely, the duration and the perceived financial burden of the 3-year training program appear to be significant deterrents.     

Factors Associated with Burnout and Frustration among Minimally Invasive Gynecologic Surgery Fellows

Study ObjectiveDetermine the prevalence of burnout and frustration among participants currently completing a fellowship in minimally invasive gynecologic surgery (FMIGS).DesignCross-sectional survey.SettingAn anonymous survey was distributed to fellows in November 2018.ParticipantsCurrent FMIGS fellows.InterventionsNot applicable.Measurements and Main ResultsA total of 57 of 83 (67.7%) FMIGS participants in American Association of Gynecologic Laparoscopists–accredited programs completed a survey regarding fellowship characteristics and experiences. Overall, 40 participants (70.2%) indicated that they were satisfied with their fellowship program experience. There were 33 participants (57.9%) who reported burnout, and 38 participants (66.7%) had experienced anxiety, depression, or extreme fatigue during the last month. Of those who reported burnout, 26 (76.5%) reported that they did not receive support from their fellowship program. Participants who experienced burnout were more likely to be in their second year (p = .003), spent less time per week doing scholarly activities (p = .048), and were less satisfied with their fellowship experience (p <.001). Participants who experienced anxiety, depression, or extreme fatigue had more cofellows in their program (p = .031), worked on average more hours per week (p = .020), and were more often required to practice obstetrics in their fellowship (p = .022).ConclusionBurnout symptoms are common among physicians across multiple specialties. Our findings suggest that this issue is prevalent among FMIGS participants. In addition, there is a lack of access to emotional and psychologic support programs for fellows experiencing burnout. We hope that this study will prompt attention to this important topic by both individual programs and American Association of Gynecologic Laparoscopists as a society to increase awareness and access to resources and promote wellness for fellows.     

Laparoscopic colostomy in gynecologic cancer

Study ObjectiveThe purpose of our study was to report on our case series of 7 patients with gynecologic cancer who underwent laparoscopic colostomy for elective fecal diversion. Our aim was to retrospectively estimate feasibility, safety, and efficacy of the laparoscopic approach in the setting of gynecologic malignancy, given the high incidence of earlier abdominal surgery and pelvic radiation treatment in this select population.DesignRetrospective chart review (Canadian Task Force classification I).SettingUniversity of Texas, M.D. Anderson Cancer Center.PatientsAll patients with a history of gynecologic cancers who underwent laparoscopic colostomy during the study period.InterventionsWe retrospectively reviewed all patients who underwent elective laparoscopic diverting colostomy in our department of gynecologic oncology. Surgical indications, medical history, operative and stomal complications, estimated blood loss, return of bowel function, and length of hospital stay were collected.Measurements and Main ResultsSeven patients underwent laparoscopic colostomy during the study period. Six of these patients underwent an end descending colostomy, and 1 patient underwent a loop colostomy. Indications included rectovaginal fistula (n = 5), colonic/pelvic fistula (n = 1), or large bowel obstruction (n = 1). No intraoperative or postoperative complications occurred, nor did any conversions to laparotomy. The median blood loss was 50 mL (range 10–75). Median operative time was 102 minutes (range 69–159). Six (86%) patients had a history of pelvic radiation. In addition, 3 (43%) patients had a history of laparotomy. The median patient weight was 59.8 kg (range 47.1–82.2). The median time to tolerance of a regular diet was 2 days (range 1–3) and the median length of hospital stay was 3 days (range 2–4). No immediate or delayed stomal complications were noted with a median follow-up of 6 months (range 1–15).ConclusionLaparoscopic colostomy in advanced gynecologic cancer may be a safe and feasible technique with minimal morbidity, rapid return of bowel function, and short hospital stay.