Female Pelvic Medicine and Reconstructive Surgery Fellowship
Handbook
The Fellowship Handbook has been developed as an explanatory tool for the fellows and fellowship applicants. It
describes all requirements of this fellowship, many of which are set by the ACGME, UAB GME or the American
Boards of Obstetrics and Gynecology and Urology. Each fellow should review this in its entirety at the beginning the
fellowship and applicable parts of it throughout the duration of the fellowship.
Table of Contents
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
XVIII.
XIX.
XX.
XXI.
Pages
General Description of Fellowship
General Goals, Objectives and Strengths
Organization Description of Fellowship
Fellowship Staff
Fellow Rotations
Weekly Schedules
Levels of Supervision for Fellows in FPMRS
Escalation of Care
Bedside Procedures
Transitions of Care
Competency Based Learning Requirements
Section1: Competency Objectives
Section2: Learning Objectives (ABOG)
Section 3: Milestones
Research Requirements
Academic and Service Portfolio
Healthstream Requirements
Policies and Procedures for Duty Hours and Work Environment
Policy for Moonlighting
Vacation, Sick and Maternity
Case List
Fellow Competency Evaluations and Assessments for Feedback and Advancement (general description)
Responsibilities of the Fellowship Faculty
Responsibilities of the Fellow in Female Pelvic Medicine and Reconstructive Surgery
1
2
3
4
7
8
9
12
15
16
17
19
44
47
48
49
53
55
58
59
61
61
I. General Description of Fellowship
The Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Fellowship at the University of Alabama at
Birmingham is accredited by the ACGME and is compliant with ACGME Program Requirements. It is a three
year fellowship for gynecologists and two year fellowship for urologists (unless the urologist desires to do a
three year fellowship). To qualify for this fellowship, the applicant should have completed or plan to complete
a residency program in Obstetrics and Gynecology or Urology in the US or Canada which is in good standing
with the American Board of these specialties. Each fellowship includes the equivalent of 12 months of
research, which may be basic science or clinically oriented, interspersed with 24 or 12 months of clinical
rotations primarily in Urogynecology, and Urology, as well as, one to two months of Geriatrics. A Colorectal
Surgery rotation is available as an elective. The Fellowship faculty includes five Urogynecologists, two
Urologists, two Geriatric Specialists, two Colorectal Surgeons, and a Radiologist. Fellows are trained in the
evaluation and treatment of women with all pelvic floor disorders. Both surgical and non-surgical approaches
to treatment are emphasized. Fellows are also prepared for academic careers via full participation in research
projects, grant development, presentations at national meetings, and journal publications. A Thesis Project is
required. Fellows are required to complete courses or equivalent training in quantitative techniques of
biostatistics and other areas related to research. Completion of master's level graduate degrees concurrent
with Fellowship Training is offered.
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II. General Goals, Objectives and Strengths
A. Educational objectives:
1) To broaden the Medical knowledge in Female Pelvic Medicine in a multidisciplinary fashion by educating fellows
in the basic science, anatomy, physiology and benign pathology of the pelvic floor including the lower urinary tract,
pelvic support structures, and the distal GI tract.
2) To provide advanced training of fellows in the clinical care (both surgical and non-surgical) of patients with
disorders of the pelvic floor. This will involve problem-based learning and improvement based on investigative
evidence.
3) To instruct and mentor fellows in research techniques: the planning and performing of meaningful research in this
subspecialty field.
4) The above objectives will be met through improvement in interpersonal communication skills by which
collaborations will be established. To accomplish this, professionalism, systems based team work, and adherence to
ethical principles will be necessary.
B. Goals:
1) The primary goal of the fellowship at the University of Alabama at Birmingham (UAB) is to train OB/GYN and
Urology physicians to have a broad knowledge base and broad expertise in female pelvic medicine and
reconstructive pelvic surgery. This should also increase research efforts in this area which has been relatively
neglected. The combination of increased knowledge, improved clinical care, and sound research should thus improve
the healthcare of an increasing population of women with these conditions.
2) A secondary goal of the program is to improve the education of residents, students, nurses and other healthcare
providers in obstetrics and gynecology, urology, and geriatric medicine at our institution.
C. Perceived strengths:
1) An unselfish collaboration of multiple specialties including gynecology, urology, geriatric medicine, behavioral
psychology and radiology (as evidenced by the existing Genitourinary Disorders Center established in 1997 and
Genitorectal Disorders Center established in 2002 through which multidisciplinary clinical care and research are
performed).
2) Large and diverse clinical case volume.
3) Excellent research opportunities.
4) Excellent facilities for patient care, teaching and research all located within a single, large academic medical
center. The majority of the fellow’s time is spent at UAB Hospital and clinics which includes The University Hospital,
The Women and Infants Center, UAB Highlands, and The Kirklin Clinic and their research facilities. All are a part of a
large referral institution where both clinical and academic functions are performed.
5) Diverse faculty with expertise in teaching basic science, diagnostic techniques, conservative treatments, surgery
and in mentoring research.
6) We have shown that the organization and collaboration between various faculty and fellows has worked well as
evident by the productivity of our present fellows and graduating fellows and by their meeting the requirements of
the Boards.
3
III. Organization Description of Fellowship
General Organization:
Fellows are involved in both In-patient and out-patient teaching during each of their rotations. At this time, all of the
teaching is performed at University Hospital, the Women’s and Infants Hospital (WIC), UAB Highlands and The Kirklin
Clinic (TKC) all of which are part of the University of Alabama at Birmingham Hospitals and Clinics (UAHC).
In-patient teaching is organized within each clinical service (Urogynecology, Urology, and Geriatrics) and Colorectal
Surgery if desired. Teaching includes:
(1) Rounds attended by the fellows, faculty members, residents, and students,
(2) Didactic presentations or interactive conferences held in addition to patient rounds, and
(3) Interactive sessions prior to, during, and/or after surgical procedures. Each surgical procedure is attended by a
faculty member and the fellow progressively assumes more and more responsibility in the performance of surgical
procedures.
Outpatient teaching is conducted at the WIC and Kirklin Clinic. While rotating on the individual services, fellows will
attend clinic with FPMRS faculty members in urogynecology, urology, and colorectal surgery and geriatrics one to
four half days weekly and become proficient in evaluation, treatment choices, patient consultation, and the
performance of various outpatient evaluations and treatments (outpatient or inpatient as is appropriate). These
include urodynamics (simple, complex and video), cystoscopy, Botox and neuromodulation therapy, urethral bulking
injections, pessary choice and utilization, excision of small lesions, various nerve blocks, and behavior and
biofeedback therapies. In addition, the importance of accurate record documentation, billing and correspondence
with referring physicians, family members, etc. is emphasized and critiqued.
The fellow’s direct responsibilities in the clinic progressively increase during the first year during which he/she works
in the attending physicians’ clinics (see Section XIX). Beginning in the second year of fellowship, the urogynecology
fellow will see new and referral patients with incontinence, prolapse, and/or anorectal disorders, as well as some
general gynecology or urology patients, in his/her own Friday PM clinic which will alternate with the other senior
(2nd or 3rd year) urogynecology fellow every 6 months. The fellow will perform appropriate evaluations including
urodynamics, cystoscopy, anorectal evaluation or other appropriate procedures; employ outpatient treatment
measures; schedule surgery and counsel patients and family members concerning the procedures. Fellows will follow
their own “continuity” patients throughout their care process including preoperative and postoperative assessments
during each of these time periods. These clinics are held at the WIC three Fridays each month and at Kirklin Clinic
one Friday where urodynamics and other outpatient procedures are performed. A faculty member is assigned to
each of these clinics and all patient care will be overseen. (Direct Supervision immediately available). Urology Fellow
Continuity clinics will be held in the urology space at Kirklin Clinic and will begin very early in the fellowship under
the direction of Drs. Wilson and Lloyd. These will be held weekly.
Supervision in ambulatory unit and operating room (also see Section V):
Fellows are supervised by faculty members at all times. Faculty members are in attendance in the operating room
during the critical portion of all procedures and, throughout the procedures during the initial phase of the fellow’s
training. The fellow’s responsibilities increase based on individual assessments of expertise and with experience;
he/she may assist residents, with the faculty member serving as a second assistant. Direct supervision or direct
supervision immediate availability will be available during all regular work days and direct supervision available on
weekends, nights, and holidays.
In the outpatient unit, the fellow also sees faculty patients with different faculty members, learning evaluation
techniques, outpatient treatment procedures and observing various methods of history taking, counseling, etc.
Fellows will immediately communicate any complication or unusual circumstance arising in patient care, in surgery,
clinic, or other patient care areas to the supervising physician. This would naturally include admissions to ICU or end
of life decisions.
4
Specific Learning Objectives are expected to be met throughout the fellowship as outlined in section IX. These have
been developed by the Boards and this Faculty. The fellows are instructed to prepare informal didactic lectures or
group discussions on these topics which are presented during their rotations. Fellow clinical performance and
knowledge is evaluated by faculty at the end of each 1, 2 or 3 month rotation and by patients, staff, students and
residents throughout the fellowship.
Conferences:
Conferences include General Conferences with attendance required by all fellows and Rotation Conferences with
attendance required when the fellow is on the specific rotation.
General Conferences:
Fellows Conference (1st Wednesday of each month at 5:00 PM)
9 of the 12 conferences would be Milestone Conferences in which case directed discussions related to the following
Milestone learning topics selected by our subspecialty’s education committee will be directed by Dr. Ellington, Dr.
Wilson, Dr. Varner or other Faculty members. Fellows will have a schedule of these conferences at the beginning of
each academic year, one month before the process starts (this year in early September), in order to know which
Milestone topics to study.
The general topics are:
General Pelvic Floor Evaluation and anatomy and physiology of the female pelvic organs
UI and Overactive Bladder physiology, pathophysiology and treatment
Anal Incontinence & Defecatory problems: physiology, dysfunction and management
POP: demographics evaluation and management
Urogental Fistula & Urethral Diverticulae: pathophysiology and Treatment
Painful Bladder Syndrome: definitions, possible pathophysiology and Treatment
UTIs: pathophysiology and management
Neurourology (will be divided into 2 conferences)
Other interactive conferences on these topics may be scheduled at other times by various faculty members.
During the Milestone Conferences, fellows will be asked direct questions or may be asked to discuss various aspects
of the Milestone. Junior level fellows will be given more basic questions but if doing exceptionally well; will have
their chance to show a higher level of knowledge. Fellows of different levels of training will be expected to exhibit
different levels of knowledge and patient care. Examples of where fellows should be at each level are demonstrated
in the FPMRS Milestone list which is in the Website. Competencies of Medical Knowledge, Patient Care and
Communication Skills of each fellow will be assessed by each faculty member present. These assessments will be
compiled as part of the overall milestone assessment on MedHub and immediate feedback regarding performance
will be given to the individual fellows by faculty.
Other Wednesday Conferences:
In addition to the 9 milestone conferences, two other Wednesday Conferences will be scheduled including one
or two on research design and statistical considerations and/or special “state of the art” lectures by our faculty
or visiting faculty. One conference at the end of the academic year will be reserved for Fellows Thesis
presentations.
Rotation Conferences:
Urogynecology Rotations:
Monday AM Surgical Conference, (6:30 AM)
The fellows, residents and students on Urogynecology, meet with Dr. Varner to discuss selected surgical procedures
including discussions of indications, alternatives, and choice, as well as, technique, complications, and avoidance
thereof. Reading on the procedures prior to each session is encouraged.
Tuesday Resident-Student Conference (7:00 AM):
On the every Tuesday except the last the fellows will alternate with each other and division faculty in leading a 3045min lecture or interactive discussion on a wide array of FPMRS specific topics, as well as general gynecologic
subjects. These lectures are attended by both the rotating Urogyn and GYN residents and medical student teams.
5
The intent of the lecture series is to provide teaching/learning experiences for the fellows while covering CORE
Curriculum Objectives as outlined by CREOG for the residents. Presentations and Interactive Conferences presented
by fellows will be evaluated by faculty and residents in the audience.
The last Tuesday of each month and will be attended by fellows, faculty and interested others in 10th Fl WIC Conf.
Rm. One faculty member (perhaps a Gen. Gyn or one of us) would concurrently give the Resident and Student
conference that same week on 5th Floor. The other Tuesday AM conferences would continue as presently designed.
Six of these Tuesday Fellowship conferences would cover selected “Landmark” papers from the PFDN and UITN or
other selected papers that will make a major impact to our specialty. There would be two (occasionally one) papers
discussed at each of these conferences with a fellow presenter and open discussion.
3 or 4 of these conferences would be interactive case study conferences related to urodynamic or genitorectal
evaluations, neuromodulation or other selected cases.
2 or 3 conferences (Mini Protocol Conferences) would be designed to introduce research ideas to the diverse group
(this was requested by the members of the Program Evaluation Committee). Mini research protocols would be
developed by individual fellows or faculty members (or more than one person) and submitted to the group at least
two weeks prior to these conferences. Each fellow or faculty member would rank the submitted mini protocols and
the one , two, or more proposals ranked highest would be discussed and, if it was felt by the group to merit further
consideration, an “ interested” working group could be designated who would develop a subsequent plan for
potential implementation. This could allow for one or more collaborative fellowship projects each year in addition to
what is done now and should be educational to all involved. Some of these projects would be small “problem based
learning and improvement projects”, but some more substantial projects could receive funding. A selected
statistician, Allie Howell or Vel Willis and Dr Richter would be expected to participate in these conferences to help
guide the process when a project is decided to be worthwhile and feasible.
Friday 12:30 PM:
Ob/GYN Department Morbidity and Mortality Conference and Grand Rounds conferences are each held twice
monthly. They are, for the most part interactive and include Urogynecology topics ¼ of the time. Fellows’ attendance
is mandatory unless the fellow is unable to leave an ongoing surgical case.
Fellows are also expected to participate in Friday PM pig lab surgical sessions, with residents and perform and teach
general techniques and will develop simulation of urogyn procedures when time and animal availability permits.
Urology Conferences:
Tuesday:
6:00 AM – Urology AM Rounds as applicable
7:00 AM – Urology/Urogynecology Weekly Lecture (M&M conference once a month, journal club once a month, and
didactic presentations by urology residents and faculty members twice a month).
Geriatric Conferences:
The Geriatric Clinical Conference on Tuesdays at noon
Center for Aging Scientific Seminar Series Fridays at noon, variable topics related to geriatrics are presented.
Continence Journal Club meets at 9:30 a.m. on Tuesdays. The Journal Club is a teleconference with all members of
the Southeast Center of Excellence in Geriatric Medicine which focuses on published articles on incontinence.
6
IV. Fellowship Staff
Fellows: The number of fellows may vary between three and four at any one time.
Core Faculty Members*: The faculty members who have “contact” with one or more fellows at least eight hours
weekly. At this time, core faculty will include the Urogynecology Faculty and Urology Faculty.
Other Faculty Members: Geriatric Continence Faculty**, Colorectal Faculty***, Radiology Faculty****, and
Non-physician Faculty such as two nurse practitioners functioning in these same subspecialties. Presently,
colorectal rotations will be elective; however, they may become regular rotations in the near future.
Faculty Email Address and Contact numbers
Dr. Holly E. Richter*
hrichter@uabmc.edu
Dr. Alicia Ballard*
aballard@uabmc.edu
Dr. Robert E. Varner Jr.*
evarner@uabmc.edu
Dr. Robert Holley*
rholley@uabmc.edu
Dr. David Ellington*
dellington@uabmc.edu
Dr. L K Lloyd*
klloyd@uabmc.edu
Dr. Tracey S Wilson*
traceywilson@uabmc.edu
Dr. Patricia S Goode**
pgoode@uabmc.edu
Dr. Alayne D Markland**
amarkland@uabmc.edu
Dr. Jamie A Cannon***
jacannon@uabmc.edu
Dr. Melanie S Morris***
msmorris@uabmc.edu
Dr. Mark E Lockhart****
mlockhart@uabmc.edu
Jeannine McCormick, CRNP jmccormick@uabmc.edu
(205) 934-3180
(205) 996-2182
(205) 934-3180
(205) 934-3180
(205) 975-3587
(205) 975-0088
(205) 996-8765
(205) 934-3259
(205) 558-7064
(205) 996-4958
(205) 996-4132
(205) 934-7130
(205) 801-8935
Research Nurse Managers: Allie Howell ahowell@uabmc.edu, Velria Willis vwillis@uabmc.edu.
Administrative Faculty:
Fellowship Director
Co-Director Urology
Director of Research
Dr. Robert E. Varner Jr.
Dr. Tracey Wilson
Dr. Holly E. Richter
Fellowship Competency Committee: Drs. Varner, Wilson, Lloyd, and Richter
Fellowship Coordinator: Julie Burge jburge@uabmc.edu (205) 934-2569.
7
V. Fellow Rotations
Block Diagram by Month
Academic Year 2014- 2015
st
One 1 yr. Urogyn Fellow (UGF1), Two 2rd year Urogyn Fellows (UGF2a, UGF2b)
UGF1
UGF2a
UGF2b
Jul
UGa
UGb
R
Aug
UGb
R
UGa
Sep
U
UG
R
Oct
UG
R
U
Nov
G/R
U
UG
Dec
U
UG
R
Jan
R
R
UG
Feb
G/R
U
UG
Legend: Rotations
UG (a) rotation: Drs. Varner/Ellington Service
UG (b) rotation: Drs. Richter/Holley/ Ballard
UG rotation: Primarily surgery with all UG faculty.
Mar
UG
U
R
Apr
UGb
UGa
U
May
U
R
UG
Jun
R
UG
U
UG – Urogynecology
G/R – Geriatrics/Research
R – Research
U – Urology
Two year Urology fellows will have 9 to 10 Urogyn rotations during their fellowships.
Urogynecology fellows will have 9 urology rotations during their fellowship.
Two year Urology Fellows: will do 1 month of Geriatrics/Research and one 2 fellow uro/gyn slot which is equivalent
to one research slot their first year.
If a Urology fellow chooses to do three years, his or her rotations will be the same as Urogynecology fellows.
Elective months in Colorectal Surgery, which include ½ time on colorectal clinical service and ½ research time, can
be substituted for a research month in years 2 or 3. This will still allow an equivalent of more than 12 months of
research.
Geriatric/Research rotations are 2/3 research.
Urogynecology rotations, UG (a&b), include at least 2 or 3 half day research slots.
Fellows are also allowed to use 2 weeks of a research month to go to a site in Africa where they care for patients
with significant injuries from child birth, during which time research data is collected.
8
VI. Weekly Schedules
Urogynecology Weekly Schedules
(UG) ONE FELLOW ON Urogyn ROTATION
Monday:
06:15 AM – Floor Rounds as applicable
06:30 AM – Preoperative Conference with Dr. Varner and Rotating Urogyn Residents
7AM – 5PM - OR with Dr. Varner
4PM – 5PM – Post-operative Rounding as applicable
Tuesday:
06:15 AM – Floor Rounds as applicable
7 AM – Tuesday AM Lecture Series – Rotating Assignments
8AM – 5PM – Dr. Ballard OR
4PM – 5PM – Post-operative Rounding as applicable
4PM – 5PM – Dr. Richter Pre-operative meeting
Wednesday:
06:15 AM – Floor Rounds as applicable
6:30 AM – 5PM Dr. Richter OR
4PM – 5PM – Post-operative Rounding as applicable
5PM-6PM: Urogynecology Conference (1st Wednesday of the Month)
Thursday:
06:15 AM – Floor Rounds as applicable
7 AM – 5PM – Robot Surgery with Dr. Ballard the 1st and 3rd of the month and GRDC with Dr. Richter on the 2nd and
4th of the month, (research/office afterwards)
4PM – 5PM – Post-operative Rounding as applicable
Friday:
06:15 AM – Floor Rounds as applicable
7 AM – 12:30PM – OR Coverage (Dr. Ellington or Dr. Holley)
12:30PM – 1:30PM – Department Resident Conference/M&M Conference
1:30PM – 5PM - Office/Research Time/OR Coverage as applicable Fellows own clinic when on clinic service
________________________________________________________________________
(UGa) Dr. Ellington and Dr. Varner Service (TWO FELLOWS ON Urogyn ROTATIONS)
Monday:
06:15 AM – Floor Rounds as applicable
06:30 AM – Preoperative Conference with Dr. Varner and Rotating Urogyn Residents
7AM – 5PM - OR with Dr. Varner
4PM – 5PM – Post-operative Rounding as applicable
Tuesday:
06:15 AM – Floor Rounds as applicable
7 AM – Tuesday AM Lecture Series – Rotating Assignments
8AM – 5PM – Dr. Varner clinic (1st year fellow only)
8AM –4PM – 2nd and 3rd year fellow research/office
4PM – 5PM – Post-operative Rounding as applicable
9
Wednesday:
06:15 AM – Floor Rounds as applicable
7AM - 5PM - Office/Research Time
4PM – 5PM – Post-operative Rounding as applicable
5PM-6PM: Urogynecology Conference (1st Wednesday of the Month)
Thursday:
06:15 AM – Floor Rounds as applicable
7 AM – 12AM – Dr. Varner Clinic - Urodynamics, In-Office Procedures, Preop surgical planning
4PM – 5PM – Post-operative Rounding as applicable
Friday:
06:15 AM – Floor Rounds as applicable
7 AM – 12:00PM – OR coverage for Dr. Ellington until complete- research/office
12:30PM – 1:30PM – Department Resident Conference/M&M Conference
1:30PM – 5PM - Office/Research Time/Animal Lab/OR Coverage as applicable or Fellows Clinic if on clinic service
______________________________________________________________________________________________
(UGb) – Dr. Holley, Dr. Richter, Dr. Ballard Service -TWO FELLOWS ON Urogyn ROTATIONS
Monday:
06:15 AM – Floor Rounds as applicable
7AM – 4Pm - OR with Dr. Holley at Highlands
4PM – 5PM – Post-operative Rounding as applicable
Tuesday:
06:15 AM – Floor Rounds as applicable
7 AM – Tuesday AM Lecture Series – Rotating Assignments
8AM – 5PM – OR coverage with Dr. Ballard
4PM – 5PM – Post-operative Rounding as applicable
4PM – 5PM – Dr. Richter Pre-operative meeting
Wednesday:
06:15 AM – Floor Rounds as applicable
6:30 AM – 5PM Dr. Richter OR
4PM – 5PM – Post-operative Rounding as applicable
5PM-6PM: Urogynecology Conference (1st Wednesday of the Month)
Thursday:
06:15 AM – Floor Rounds as applicable
7 AM – 1PM – Richter GRDC Coverage on 2nd and 4th of the month/OR coverage with Dr. Ballard on 1st and 3rd of the
month/Research Time/OR Coverage as applicable
4PM – 5PM – Post-operative Rounding as applicable
Friday:
06:15 AM – Floor Rounds as applicable
7 AM – 12:30PM – OR Coverage (Dr. Holley)/GRDC Coverage (Dr. Ballard)/Office/Research Time/
12:30PM – 1:30PM – Department Resident Conference/M&M Conference
1:30PM – 5PM - Office/Research Time/ Pig Surgical lab/ or OR Coverage as applicable or Fellows clinic if on clinic
service
_______________________________________________________________________________________________
10
UROLOGY Rotation Weekly Schedules
The Urology rotation consists of both inpatient and outpatient surgical procedures performed at University Hospital
and UAB Highlands as well as outpatient clinics at both The Kirklin Clinic and the Spain Rehabilitation Facility.
The following schedule provides and outline of the weekly Urology Rotation:
Monday:
7AM – 5PM: Dr. Lloyd OR Coverage – University Hospital
Tuesday:
6 AM – Urology AM Rounds as applicable
7 AM – Urology/Urogynecology Weekly Lecture (M&M conference once a month, journal club once a month, and
didactic presentations by urology residents and faculty members twice a month).
8AM – 5PM: Dr. Wilson TKC Outpatient Clinic
Wednesday:
7AM – Dr. Lloyd OR Coverage – UAB Highlands
1PM-5PM: Spain Rehabilitation Urology Clinic
5PM-6PM: Urogynecology Conference (1st Wednesday of the Month)
Thursday:
7 AM – UAB Highlands AM Rounds as applicable
7:30 AM - Dr. Wilson OR Coverage – UAB Highlands
Friday:
7 AM – UAB Highlands AM Rounds as applicable
8 AM – 5 PM: Dr. Lloyd TKC Outpatient Clinic
____________________________________________________
11
VII. Supervision for Fellows in FPMRS
Fellows, faculty members and patients are aware of the specific attending physician responsible for each patient and
will be available through the UAB paging system and, if he/she is not available the fellow will immediately contact the
on call faculty member.
Residents/fellows and faculty members should inform patients of their respective roles in each patient’s care
Faculty attending and call schedules are structured to provide residents/fellows with continuous supervision and
consultation.
Residents/fellows and other health care personnel are provided beeper numbers and have all phone numbers for
communicating with supervising faculty.
Levels of Supervision
To ensure oversight of resident/fellow supervision and graded authority and responsibility, the program has defined
the levels of supervision that is in accordance with the RRC and use the following classification of supervision:
a) Direct Supervision (Level1) – the supervising physician is physically present with the resident/fellow while
providing patient care
b) Indirect Supervision with direct supervision immediately available (Level 2) – the supervising physician is
physically within the hospital or juxtaposed site of patient care (North Pavilion, West Pavilion, Spain Wallace, Women
and Infants Center, VAMC) and is immediately available to provide Direct Supervision
c) Indirect Supervision with direct supervision available (Level 3) – the supervising physician is not physically
present within the hospital or other site of patient care but is immediately available by means of telephone and/or
electronic modalities, and is available to provide Direct Supervision
d) Oversight (Level 4) – The supervising physician is available to provide review of procedures/encounters with
feedback provided after care is delivered
Fellows are supervised by teaching staff in such a way that the fellows assume progressively increasing responsibility
according to their level of education, ability and experience. The program demonstrates that the appropriate level of
supervision is in place for all fellows who care for patients. The level of responsibility granted to fellows is determined
by the program director and/or supervising teaching faculty and is based on documented evaluations of the fellow's
clinical experience, judgment, knowledge, technical skill and the needs of the patient.
In general
a) Fellows serve in a supervisory role of residents/junior fellows in recognition of their progress toward
independence, based on the needs of each patient and the skills of the individual resident/fellow or
fellow.
b) Fellows must communicate with appropriate supervising faculty members any time there is a patient
care emergency, a situation when there is a conflict between any parties delivering patient care or
when a subspecialty surgical procedure is to be performed.
c) Fellows must be aware of their limitations and may not attempt to provide clinical services or perform
procedures for which they are not trained.
d) Faculty supervision assignments is of sufficient duration to assess the knowledge and skills of each
fellow and delegate to him/her the appropriate level of patient care authority and responsibility.
e) The program director is responsible for ensuring that all teaching faculty and residents/fellows are
educated to recognize the signs of fatigue and for implementing policies and procedures to prevent
and counteract the potential negative effects. Faculty members and residents/fellows are educated to
recognize the signs of fatigue and sleep deprivation; alertness management and fatigue mitigation
processes; and to adopt fatigue mitigation processes to manage the potential negative effects of
fatigue on patient care and learning such as naps or back-up call schedules through direct discussion
and formal educational programs (GME lecture on fatigue and management)
f) In the event that a fellow may be unable to perform his/her patient care duties, his/her faculty
supervisor will be notified in order to assume or arrange for assumption of duties by another fellow
and appropriate arrangements will be made to care for the affected fellow.
12
Female Pelvic Medicine and Reconstructive Surgery
Urogynecology or Urology Service
Level of Supervision Guidelines
Faculty Clinics including
procedure clinics
Surgical Cases
Gynecology call and
general gynecology
surgical cases while on
call
*Urogynecology Fellow
PGY 5*
Level 1
PGY 6*
PGY6**
Level 1 and 2
PGY7*
PGY7**
Level 1 and 2
Level 1
Level 1 advancing to
Level 3 when deemed
capable
Level 1
Level 3
Level 1 and 2
Level 3
** Urology Fellow
Fellow Level 1: At the beginning of the Fellowship, a fellow(s) should communicate every aspect of patient
evaluation or management plan to the attending physician(s) prior to instituting management. Faculty will “directly
supervise or perform all surgical procedures with that fellow. The attending faculty will also review the fellows
dictated consultation record or notes. For inpatient care the chief resident on Urogynecology or Urology will serve as
the manager of that service with the Fellow serving as his/her advisor. The fellow will round on all complicated
patients or patients with complications or morbidities with the residents and serve as an advisor and teacher to
those residents, but will not serve as their director or “foreman” of the team. The fellow(s) should demonstrate
adherence to the six clinical competencies and be an example to the residents. The fellow(s) will function as directed
by the attending physicians in the operating room and clinic and will be in direct communication with the attending
about all patient care. The fellow will instruct residents in pathophysiology, patient management issues and
procedures during rounds and will give formal didactic/interactive conferences to residents and students which are
attended by faculty and evaluated by all attendees.
Fellow Level 2: In the 2nd year of fellowship for a Urogynecology fellow, he/she will begin his/her own weekly
continuity clinics, and “attend” low risk gynecology surgical cases with Direct supervision available. Urogynecology
Continuity Clinics will rotate between two or three fellows each 6 to 8 month period, however if a fellow is not on
the continuity clinic schedule he/she may make arrangement to see a postop pt. or another private patient with a
problem. During the continuity clinic, the fellow will first be under direct faculty supervision (level 1) presenting
each case to the faculty member in the same clinic area. When the fellow is felt capable the faculty member will
function as a direct supervisor, immediate availability (level2) in the clinic and for inpatients as well. However, the
faculty is required to see and be directly responsible for all Medicare patients and will continue to perform daily
rounds with the fellow and residents on his/her patients. Urology fellows will function likewise and will largely see
general urology patients in their clinic.
Urogynecology fellows’ night and weekend call includes general gynecology. Urology fellows’ call includes all urology
patients. All fellows will have completed their residency training and will be qualified to manage general
gynecological problems (both medical and surgical). However, there will be a faculty member backup for night and
weekend call. All calls concerning urogynecology patients will be checked out with the attending either at the time
of the call or, if the decision is obvious to the fellow, the next morning or work day. The attending physician is
notified of all admissions and is available to come in for any surgical procedures perceived to be difficult or unusual
if he/she feels unsure as to whether the fellow might need his/her assistance. Residents are also present during
patient care including surgical cases. The fellow’s responsibility progresses as faculty sees fit. All subspecialty surgical
procedures on patients of faculty members are performed with Direct Supervision (level 1). Procedures on fellow
patients require at least level 2 supervision.
13
Fellow Level 3: At the later stages of fellowship generally early in the last year of fellowship the fellow(s) functions
more independently on his/her own patients, but with direct supervision available (level 3), or on occasion (level 4with Oversight)The fellow(s), when the Competency Committee deems he or she capable, however continues to
function with faculty supervision on faculty patients, and is still expected to discuss all of his/her surgical cases and
out of the ordinary clinical or non-surgical hospitalized patients with the attending. The fellow will occasionally take
“attending” responsibility of the inpatient services for periods of time, even on individual faculty member’s patients.
At this time, the fellow is allowed to perform or attend residents on surgical procedures performed on his or her
continuity patients. Demonstrated competency on focused assessment cases and on the other evaluative
assessments is necessary prior to this. Resident and faculty perception that a fellow is able to function well in these
situations is important to establish that the fellow can function independently after completion of the fellowship.
14
VIII. Escalation of Care
Escalation of Care:
Any urgent patient situation should be discussed immediately with the supervising attending. This includes:
• In case of patient death
• Any time there is unexpected deterioration in patient’s medical condition
• Patient is in need of invasive operative procedures
• Instances where patient’s code status is in question and faculty intervention is needed
• A patient is transferred to or from a more acute care setting (floor to ICU and vice versa)
• A patient’s condition changes requiring MET/CHAT team activation
• Any other clinical concern whereby the intern or the resident feels uncertain of the appropriate clinical plan
Timeliness of Attending Notification:
Notification of the attending should not delay the provision of appropriate and urgent care to the patient. The
fellow will notify the attending as soon as possible after an incident has occurred. If despite the best efforts,
the resident cannot reach the assigned attending, then they should notify the program director, medical
director of the service or the chair of the department for guidance.
15
IX. Bedside Procedures
Purpose:
The purpose of this policy is to provide guidance for fellows on when to notify the attending or higher supervisor
trainee when performing bedside invasive procedures.
Scope:
This policy applies to all bedside procedures performed by fellows on patients seen at University Hospital. Surgical
procedures performed by fellows on patients in the operating rooms are not covered by this policy as there are
already policies covering these situations.
Performance of Procedure:
1. All fellows performing a bedside procedure will discuss the clinical appropriateness of the procedure that might
entail risk to the patient with the attending.
2. The attending physician is responsible for determining the appropriate level of supervision required for
performing a bedside procedure, the appropriate indication for the procedures, discussion of risk-benefit with
residents and patients (as necessary), assessing the risk of the procedure, determining the qualification of the fellow
performing the procedure and providing adequate support if felt indicated.
3. It is expected that a fellow shall inform the faculty member when he/she does not feel capable of performing a
bedside procedure.
4. The fellow performing a procedure should make sure that there is adequate backup (such as attending,
interventional services, surgical services) before performing the procedure.
5. The fellow should attempt the procedure no more than two times before stopping and re-evaluating the clinical
situation and asking for a attending, interventional service, or surgical service to take over the performance of the
procedure.
6. The procedure should be aborted and alternate plans discussed with the attending when the risk of the procedure
including discomfort to the patient outweighs the benefit of repeated attempts beyond three.
7. In case of emergency, greater than three attempts can be made but should be justified with clear documentation
of the need to do so in the procedure note.
8. If a life or death patient situation is encountered immediate CPR should be initiated and the MET team should be
called STAT.
E. TEAMWORK
Residents/fellows care for patients in an environment that maximizes effective communication. This include the
opportunity to work as a member of effective inter-professional teams that are appropriate to the delivery of care in
the specialty
16
X. Transitions of Care
Purpose:
A responsibility of the Institution that sponsors Graduate Medical Education is to ensure and monitor effective,
structured hand-over processes to facilitate both continuity of care and patient safety (Common Program
Requirement VI.B.2). The ACGME has charged the institution and the programs with designing clinical assignments to
minimize the number of transitions in patient care (CPR VI.B.1), ensuring that residents/fellows are competent in
communicating with team members in the hand-over process (CPR VI.B.3), and ensuring the availability of schedules
that inform all members of the health care team of attending physicians and residents/fellows currently responsible
for each patient’s care (CPR VI.B.4).
Scope:
This policy applies to all graduate medical education training programs sponsored by the University of Alabama
Hospital
Definitions:
1. Transitions of care constitute the transfer of information, authority and responsibility during transitions in care
across the continuum for the purpose of ensuring the continuity and safety of the patient’s care.
2. Hand-off communication is a real time, active process of passing patient-specific information from one caregiver
to another, generally conducted face-to-face, or from one team of caregivers to another for the purpose of ensuring
the continuity and safety of the patient’s care. Hand-offs should occur at a fixed time and place each day and use a
standard verbal or written template. The circumstances for transitions of care may include scheduled and
unscheduled changes of assignments, at the conclusion and the commencement of assigned duty periods or call,
when the patient is transferred to another site or another team of providers (e.g. transfer within in-patient settings
and out-patient settings), and when it is in the best interest of the patient to transfer the care to another qualified or
rested provider (e.g. duty hours or fatigue).
Patient Hand off policies which are outlined by the Obstetrics and Gynecology and Urology residency programs will
apply to all inpatient Urogyncology and Urology services which fellows rotate.
 The residents on the Urogynecology Service are responsible for first call on urogynecology or female urology
inpatients during the day Monday-Friday. Handoffs occur in a quiet conference room at 5PM each week day
evening (unless another time is arranged). These PM and all weekend and holiday handoffs are performed
face to face and include the transfer of a printed “Multi-patient Rounds/Sign-Out Report” available for each
in hospital patient through Cerner. This template includes all required patient data plus written explanatory
notes on current condition, active issues, pending results and any new management plan. This constitutes
greater than the “minimal elements for a handoff template”.
 In addition, the fellow on the urogynecology service or urology service is responsible for corresponding with
the “on call” resident about any patient that is considered to have any excess risk for complications. This will
be performed after the 5PM handoff between the residents, usually by telephone.
 Weekday AM handoffs may be made by telephone between the on call gynecology resident and a
urogynecology service resident who is familiar with service patients. If there has been an admission, such
handoff is face to face and the new EMR is reviewed together. All weekend and holiday transfers are face to
face and include the forms on each patient.
The house staff members on call are responsible for notifying the Urogynecology or Urology faculty member or
fellow on call if any problems should develop involving any patient or the specific service. The disposition of the
problem will be decided on, including the need (or no need) for that physician to be present. This correspondence
should be made immediately by telephone (direct line or through the paging system).
The Impact EMR system, uses the (I-PASS) Impact Physician Handoff on all inpatients which is easily accessible by the
residents, fellows and physicians.
17
Since the Urogynecology and Urology inpatient services include individual patients for several different attendings.
In addition to the above resident to resident and service fellow to resident handoffs, individual attending physicians
are expected to “handoff” patients who have problems or are at risk for problems to the on call faculty or fellow and
to discuss with the appropriate on call resident. This will be done by telephone or in person, therefore insuring that
direct contact is made and discussion of the patients name, age, condition, care plan, pertinent evaluations which
have been performed and concerns that the attending MD has. The attending physicians also have EMR access at
home. This policy facilitates appropriate care by the on call attending and resident team should a problem develop in
such patients. The individual faculty members or fellows on service will also be responsible for communicating with
the on call division member (faculty or fellow) regarding special needs patients (inpatient and outpatient).
General Policies:
1. Hand-off communication entails direct communication.
2. Off-going provider will have at hand any required supporting documentation or tools used to convey information
and immediate access to the patient’s record.
3. All communication and transfers of information will be provided in a manner consistent with protecting patient
confidentiality and privacy.
4. Providers will afford each other the opportunity to ask or answer questions and read or repeat back information
as needed.
5. The patient will be informed of any transfer of care or responsibility, when possible.
6. The effectiveness of the program’s hand-off process will be monitored through direct observation and multiperspective surveys of resident/fellow performance. The program will review hand-off effectiveness at least annually
during the annual program evaluation meeting.
Minimal Elements of a Template:
Each residency training program that provides in-patient care is responsible for creating a patient checklist template.
At a minimum, key elements of this template should include, but are not limited to:
1. Patient information (name, age, room number, medical id number, important elements of medical history,
allergies, resuscitation status, family contacts)
2. Current condition and care plan (pertinent diagnoses, diet, activity, planned operations, significant events during
previous shift, current medications)
3. Active issues (pending laboratory tests, x-rays, discharge or communication with consultant, changes in
medication, overnight care issues, “to-do’ list)
4. Contingency plans (if/then statements)
5. Synthesis of information (“read-back” by receiver to verify)
6. Opportunity to ask questions and review historical information
7. Name and contact number of responsible resident/fellow and attending physician
8. Name and contact number of resident/fellow/attending physician for back up
18
XI. Competency Based Learning Requirements
Section 1: Lists specific competency objectives that will be ongoing throughout the fellowship and reviewed
with the fellow each six month period. The fellow and Fellowship Director will set specific competency goals
at each semiannual evaluation based on the feedback from the 360 competency evaluations and rotation
evaluations.
Section 2: Review and study of all specialty specific topics should be begun during the first year with reading
all available current literature in textbooks and review papers as, well as, learning in conferences, web based
learning programs, journal clubs, surgical labs, and while participating in patient care clinics and surgery.
Learning of these topics will continue with thorough reviews of Level I and II literature and appropriate other
papers throughout the duration of the fellowship. This section designates which topics should be completed
during each 6 month period. At the end of each rotation in Urogynecology (UG), Urology (U), and Geriatrics
Research (GR), faculty members will submit an evaluation of how well the fellow has accomplished the
specific objectives designated for that rotation. These evaluations and portfolios will be reviewed with the
fellowship director at each semiannual evaluation to ensure fellow’s adherence to these assignments. The
Focused Assessments of each designated surgical and clinical procedures, the primary research Thesis Project
and the Comprehensive Oral Examination are also included. Each of these activities or learning objectives will
include the related competency. Other research projects will be interspersed with no specific time table
required however weekly oversight by Dr. Richter will insure that appropriate progress is made.
Section 3: Milestones. See FPMRS Milestone document on website. These (23) milestones have been set by
the ACGME and Boards as the primary requirements by which fellows are determined to be capable of
practicing solo in this subspecialty (Level 4) and, in some cases, determined to have achieved “exemplary
expertise” (Level 5). All of the evaluations of fellows, which include assessment of all competences, will be
objectively tabulated by MedHub and reviewed by the Competency Committee in the spring of each
fellowship year to determine his/her, progress in achieving these Milestones. These should be reviewed by
the fellow multiple times during his/her fellowship training so that he/she can direct his/herself toward
maximal achievement. There will be Milestone Conferences (interactive between faculty and fellows) on all
Medical Knowledge and Patient care related milestones repeated each year of the fellowship.
19
Female Pelvic Medicine Milestone Topics
Patient Care PC-1 General Pelvic Floor Evaluation
PC-2
PC-3
PC-4
PC-5
PC-6
PC-7
Urinary Incontinence and Overactive Bladder Treatment
Anal Incontinence and Defecatory Dysfunction Treatment
Pelvic Organ Prolapse Treatment
Urogenital Fistulas and Urethral Diverticula Treatment
Painful Bladder Syndrome Treatment
Urinary Tract Infection (UTI)
Medical Knowledge MK-1 Pelvic Floor Anatomy and Physiology
MK-2 Urinary Incontinence and Overactive Bladder Treatment
MK-3 Anal Incontinence and Defecatory Dysfunction Treatment
MK-4 Pelvic Organ Prolapse Treatment
MK-5 Urogenital Fistulas and Urethral Diverticula Treatment
MK-6 Painful Bladder Syndrome Treatment
MK-A7 Urinary Tract Infection
MK-A8 Neuro-Urology Active
Systems-based Practice SBP-1 Computer Systems
SBP-2 Health Care Economics
SBP-3 Works and coordinates patient care effectively in various health care delivery settings and systems
Practice-based Learning and Improvement PBLI-1 Scholarly
PBLI-2 Implements Quality Improvement Project
Professionalism PROF-1 Professional Ethics and Accountability
Interpersonal Communication Skills (ICS) ICS-1 Health Care Teamwork
ICS-2 Effective Communication
20
Section I
Competency Based Requirements
Abbr: PC: Patient Care, MK: Medical Knowledge, PBL: Practice-based Learning, ICS: Interpersonal & Communication Skills, P: Professionalism, SBP: Systems-Based Practice
Gyn
Uro
PC
MK PBL
ICS
P
SBP
Level
Level
Fellow must be able to provide care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of
health. Fellows are expected to:
Patient Care
Demonstrate caring and respectful behaviors when interacting with patients and their families.
1,2,3
1,2
x
Gather essential information about patients by performing a complete and accurate medical
history and physical examination.
1,2,3
1,2
x
x
Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment.
1,2,3
1,2
x
x
Develop, negotiate, and implement effective patient management plans.
1,2,3
1,2
x
Counsel and educate patients and their families.
1,2,3
1,2
x
Use information technology to support patient care decisions and patient education.
1,2,3
1,2
x
Competently perform all medical and invasive procedures considered essential for the practice
of Female Pelvic Medicine and Reconstructive Surgery
1,2,3
1,2
x
x
Recognize problems encountered in patient care delivery and develop means of investigating
and correcting these problems.
1,2,3
1,2
X
X
Work with health care professionals, including those from other disciplines, to provide patientfocused care.
1,2,3
1,2
x
Use competency assessments for goal setting each semiannual period.
1,2,3
1,2
x
21
x
x
x
x
x
x
x
x
x
x
x
x
X
x
x
x
X
X
X
x
x
x
x
x
x
GYN
Level
Medical Knowledge
Uro
Level
PC
MK
PBL
ICS
P
SBP
Fellow must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral)
sciences and apply this knowledge to patient care. Fellows are expected to:
Demonstrate an investigatory and analytic thinking approach to clinical situations.
1,2,3
1,2
Demonstrate a sound understanding of the basic science background of Female Pelvic Medicine
Reconstructive Surgery and apply this knowledge to clinical problem solving, clinical
decision making, and critical thinking.
1,2,3
1,2
Obtain a thorough understanding of all of the learning objectives listed in section II adhering to
the time table provided.
1,2,3
1,2
x
x
x
x
x
x
x
x
x
x
x
x
GYN
Uro
PC
MK PBL
ICS
P
SBP
Level
Level
Fellows must be able to demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with
patients, patients’ families, and professional associates. Fellows are expected to:
Interpersonal and Communication Skills
Sustain therapeutic and ethically sound relationships with patients, patients’ families, and
colleagues.
1,2,3
1,2
Provide effective and professional consultation to other physicians and health care
professionals.
1,2,3
1,2
Elicit and provide information using effective listening, non-verbal, explanatory, questioning,
and writing skills.
1,2,3
1,2
Demonstrate effective communication with patients in language that is appropriate to their age
and educational, cultural, and socioeconomic background.
1,2,3
1,2
Maintain comprehensive, timely, and legible medical records.
1,2,3
1,2
Demonstrate effective communication with others as a member or leader of a health care team
or other professional group.
1,2,3
1,2
Complete CERT Creating Effective Resident Teachers Program and give effective educational
presentation to residents and medical students at UAB, presentations of research at
national subspecialty meetings.
1,2,3
1,2
Use competency evaluations and presentation evaluations for goal setting each semiannual
period.
22
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
GYN
Uro
PC MK
PBL
ICS
P
SBP
Level
Level
Fellow must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse
population. Fellows are expected to:
Professionalism
Demonstrate respect, compassion, integrity, and responsiveness to the needs of patients and
society that supersedes self-interest.
1,2,3
1,2
x
x
Demonstrate accountability to patients, society, and the profession.
1,2,3
1,2
x
x
 Demonstrate uncompromised honesty.
1,2,3
1,2
x
x
 Develop and maintain habits of punctuality and efficiency.
1,2,3
1,2
x
 Maintain a good work ethic (i.e., positive attitude, high level of initiative).
1,2,3
1,2
x
Demonstrate a commitment to excellence and ongoing professional development.
1,2,3
1,2
Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care.
1,2,3
1,2
Describe basic ethical concepts such as: autonomy, beneficence, justice, and nonmalfeasance.
1,2,3
1,2
Describe the process of informed healthcare decision making, including the elements that must
exist and the specific components of an informed-consent discussion.
1,2,3
1,2
x
Discuss important issues regarding stress management, substance abuse, and sleep deprivation.
1,2,3
1,2
x
1,2,3
1,2
x
1,2,3
1,2
x
x
x
1,2,3
1,2
x
x
x
x
1,2,3
1,2
x
x
x
x
1,2,3
1,2
x
x
x
 Describe current standards for the protection of health-related patient information.
1,2,3
1,2
x
x
x
 List potential sources of loss of privacy in the health care system. (P, SBP)
1,2,3
1,2
x
x
 List preventive stress-reduction activities and describe their value.
 Identify the warning signs of excessive stress or substance abuse within one’s self and in
others.
 Intervene promptly when evidence of excessive stress or substance abuse is exhibited by
oneself, family members, or professional colleagues.
 Demonstrate an understanding of the signs of sleep deprivation and intervene promptly
when they are exhibited by oneself or professional colleagues.
Maintain confidentiality of patient information.
23
x
x
x
x
x
x
x
x
x
x
x
x
Professionalism
GYN
Level
Uro
Level
Demonstrate sensitivity and responsiveness to the culture, age, sexual preferences, behaviors,
socioeconomic status, beliefs, and disabilities of patients and professional colleagues.
1,2,3
Describe the procedure for, and the significance of, maintaining medical licensure, board
certification, credentialing, hospital staff privileges, and liability insurance.
PC
MK
PBL
ICS
P
SBP
1,2
x
x
2,3
2
x
x
x
GYN
Level
Uro
Level
ICS
P
SBP
x
x
Use competency assessments for goal setting each semiannual period.
Practice-Based Learning and Improvement
PC
MK
PBL
Fellow must be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.
Identify areas for personal and practice improvement and implement strategies to enhance
knowledge, skills, attitudes, and processes of care, as well as making a commitment to
life-long learning.
x
x
x
x
x
1,2
x
x
x
2/3
2
x
Demonstrate receptiveness to instruction and feedback.
1,2,3
1,2
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
1,2,3
1,2
Use information technology to manage information, access online medical information, and
support their education.
1,2,3
Facilitate the learning of students and other health care professionals.
Participate actively in one or more planned project to improve the practice of FPMRS at UAB.
Analyze and evaluate personal practice experience and implement strategies to continually
improve the quality of patient care provided using a systematic methodology.
Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health
problems.
Obtain and use information about their population of patients and the larger population from
which their patients are drawn.
Use competency assessments for goal setting each semiannual period.
24
1,2,3
1,2
2/3
2
1,2,3
x
x
x
x
x
x
x
x
1,2
x
x
1,2,3
1,2
x
x
x
1,2,3
1,2
x
x
x
x
x
x
x
x
x
GYN
Level
Systems-Based Practice
Uro
Level
PC
MK
PBL
ICS
P
SBP
Fellow must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on
system resources to provide care that is of optimal value. Fellows are expected to:
Describe how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society, and how these
elements of the system affect their practices. Describe the processes for obtaining
licensure, receiving hospital privileges and credentialing.
2/3
2
x
x
1,2,3
1,2
x
x
 List common systems of health care delivery, including various practice models.
2/3
2
x
x
 Describe common methods of health care financing.
2/3
2
x
x
 Discuss common business issues essential to running a medical practice.
2/3
2
1,2,3
1,2
Practice cost-effective health care and resource allocation that does not compromise quality of
care.
1,2,3
1,2
x
x
x
Advocate for quality patient care and assist patients in dealing with system complexities.
1,2,3
1,2
x
x
x
 Recognize that social, economic and political factors are powerful determinants of
health and incorporate these factors into how they approach patient care.
1,2,3
1,2
x
x
x
 Demonstrate knowledge of disparities in health and health care in a variety of
populations.
1,2,3
1,2
x
x
x
 Recognize the role of the women’s health provider to advocate for patients, particularly
poor and vulnerable women, and to help develop methods of care that are effective,
efficient, and accessible to all women.
1,2,3
1,2
x
x
x
2/3
2
x
x
x
1,2,3
1,2
x
x
x
2/3
2
x
x
x
1,2,3
1,2
x
x
x
Describe how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
 Apply current procedural and diagnostic codes to reimbursement requests.
 Be aware of ACOG and AUG and community resources and advocacy on behalf of
underserved and vulnerable populations such as poor women and teenagers.
 Communicate effectively about women’s health concerns to family and community
groups.
 Recognize the role of the physician in legislation as it relates to women’s health policy.
Communicate well with physicians and other providers in specialized other than your own to
optimize the overall care of patients.
25
x
x
x
x
x
x
x
x
x
x
x
x
Systems-Based Practice
GYN
Level
Uro
Level
PC
MK
PBL
ICS
P
SBP
Acknowledge that patient safety is always the first concern of the physician.
1,2,3
1,2
x
x
x
x
x
x
 Demonstrate the ability to discuss errors in management with peers and
patients to improve patient safety.
1,2,3
1,2
x
x
x
x
 Develop and maintain a willingness to learn from errors and use errors to improve the
system or process of care.
1,2,3
1,2
x
x
x
x
 Participate in hospital/departmental QI activities and Patient Safety initiatives
1,2,3
1,2
x
x
x
x
 Recognize the value of input from all members of the health care team and methods by
which to facilitate communication among team members.
1,2,3
1,2
x
x
x
x
x
 Demonstrate understanding of institutional disclosure processes and participate in
disclosure and discussions of adverse events with patients.
2/3
2
x
x
x
x
Partner with health care managers and health care providers to assess, coordinate, and improve
health care and know how these activities can affect system performance.
1,2,3
1,2
x
x
x
x
 Describe the process of quality assessment and improvement including the role of
clinical indicators, criteria sets, and utilization review.
2,3
2
x
x
x
x
 Participate in organized peer review activities and use outcomes of such reviews to
improve personal and system-wide practice patterns.
1,2,3
1,2
x
x
x
x
x
 Demonstrate an ability to cooperate with other medical personnel to correct system
problems and improve patient care.
1,2,3
1,2
x
x
x
x
x
1,2,3
2
x
x
x
x
 List the major types and providers of insurance.
2/3
2
 Describe the most common reasons for professional liability claims.
2/3
2
 Describe a systematic plan for minimizing the risk of professional liability claims in
clinical practice.
2/3
2
 Describe basic medical-legal concepts regarding a professional liability claim and list the
steps in processing a claim.
2/3
2
Risk management and professional liability
Use competency assessments for goal setting each semiannual period.
26
x
x
x
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Section II
FPMRS Specialty Specific Objectives
Urogynecology Fellow or Three year Urology Fellow
Acquired knowledge assignments for year 1 with completion expected during the first 6 months
Pelvic Floor Anatomy (UG)
Demonstrate knowledge of pelvic anatomy, including genital, urinary, colorectal, and musculoskeletal elements.
Describe the vascular and nerve supply to each of the pelvic organs and structures, including the external genitalia, uterus, kidney, urethra,
bladder, and recto-sigmoid.
Explain the normal anatomic supports of the vagina, rectum, bladder, urethra, and uterus, including the bony pelvis, pelvic floor nerves and
musculature, and connective tissue.
Describe the inter-relationships and function of the pelvic organs and support mechanisms.
MK
Describe the anatomy, borders, and content of the pelvic and retroperitoneal spaces.
MK
Describe the anatomy of the anterior abdominal wall.
Describe the vascular and nerve supply to the urethral and anal sphincter mechanisms.
Describe and interpret normal and abnormal reproductive and urinary tract anatomy.
MK
MK
MK
Pelvic Floor Physiology (UG)
Describe the normal function of the lower urinary tract during storage and micturition and the mechanisms responsible for urinary continence.
Describe the physiology of colorectal function.
MK
Describe normal utero-vaginal physiology and function.
Overactive Bladder (U) (UG)
Cite the prevailing international definitions of urinary frequency urgency nocturia and overactive bladder syndrome.
Discuss the indications characteristic findings and limitations of the following methods that may be used to diagnose overactive bladder
syndrome: Clinical symptoms, Urinary diary, Urine, urethral cervical culture, Cystometry, Cystourethroscopy.
General Pelvic Floor Evaluation (UG)
Elicit a comprehensive medical history including a directed history that identifies all pelvic floor disorders, their type and severity.
Urinary Incontinence (U) (UG)
Perform a directed pelvic floor history including appropriate use of prevailing international terminology related to the signs and symptoms of
urinary incontinence and lower urinary tract function and evaluation of: Urinary symptom severity and bother, including use of urinary diaries
pad tests, and condition-specific bother, and quality of life questionnaires. Past medical obstetrical and surgical histories. Structural anatomic
and congenital malformations. Current medications and their effects on urinary symptoms. Other organ systems including the nervous system
and their effects on lower urinary tract function. Prior treatments and patient’s response.
Surgical Treatment of Urinary Incontinence (U) (UG)
Assist in and perform surgical procedures for stress incontinence which are felt to be applicable today (mid-urethral sling ( retropubic and
transobutrator), Burch procedure, and autologous fascial slings. Understand the basic techniques of the commonly performed procedures in the
past. ( Kelly and Pubo urethral ligament plications, MMK, Stamey, Raz, Pereyra and modifications thereof)
MK
MK, PBLI
27
MK
MK
MK
MK
MK
PC
MK, PC
PC
Describe indications, contraindications, intra and post operative complications, and their management , and avoidance, as well as, success rates
of the following incontinence procedures: Periurethral bulk injections, Retropubic urethropexy (Marshall-Marchetti-Krantz, Burch, and
paravaginal defect repair),Sling procedures, Fascial (fascia lata, rectus fascia),and Synthetic, Retropubic, and Transobturator Midurethral Sling
procedures
Identify evaluate and know management of complications associated with continence surgery.
MK, PC
Discuss role of urodynamic testing when planning continence surgery including.
MK
Discuss alternatives advantages disadvantages and evidence for prophylactic continence procedures at the time of vaginal and abdominal
prolapse surgery in stress continent women.
Behavioral Treatment (GR)
Describe each of following behavioral treatments used to treat urinary incontinence. Timed voiding, Bladder training, Biofeedback, Pelvic floor
muscle training, Electrical stimulation, other evidenced based treatments.
Counsel patients on each of the behavioral interventions listed above specifically: List indications and contraindications, Cite published
effectiveness rates, Explain frequency and types of side effects, Discuss long-term continuation and compliance rates,
Evaluate the level of evidence for success and complication rates,
List costs of treatment regimens.
Functional Treatment (GR)
Describe the following functional factors related to urinary incontinence: Mobility issues, Fecal impaction, Dementia, Hyperglycemia, Infection,
Nocturnal polyuria, Medications, Sedatives, Hypnotics, Diuretics, Antidepressants.
MK, PBLI, ICS
Discuss the role and risks of each of the following functional interventions in the management of urinary incontinence: Fluid management,
including evening restrictions, Change of pharmacologic agents or timing of their use (diuretics), Avoid nocturnal diuresis with decompression,
CPAP, Optimize control of allergies, bronchitis, and chronic cough, Modification the environment (e.g., use of a bedside commode),Optimize
bowel function and minimize constipation and fecal impaction, Modification of clothing to compensate for decreased dexterity, Intermittent
self-catheterization, Absorbent products, Pessaries or tampons, Other evidenced based treatments, Counsel patients regarding hazards and
limitations of chronic indwelling catheters.
Fecal Incontinence Evaluation (UG)
Elicit a comprehensive pelvic floor history including the following:
Symptoms associated with fecal incontinence such as diarrhea, fecal urgency constipation or defecatory problems.
Prevailing international terminology for anal incontinence.
Determine fecal incontinence duration and severity, precipitating factors, and lifestyle modifications.
Evaluate past medical, obstetrical, and surgical histories.
Structural, anatomic and congenital malformations.
Evaluate current medications and their effect on colorectal function.
Evaluate other organ systems including neurologic, lower urinary tract and pelvic support, and their possible effects of the colorectal system.
Determine psychosocial and psychosexual effects of fecal incontinence.
Determine all prior therapies and responses.
Perform a focused physical examination including:
Neuromuscular examination with assessment of pelvic floor muscle and anal sphincter strength, pelvic floor reflexes, and perineal and anal
sensory function.
Identification of anal fistula, fissures, or scarring, perineal descent, rectal prolapse, hemorrhoids, tumor, and anal sphincter disruptions.
MK, PC, ICS
28
MK, PC
MK
MK, PC, PBLI,
ICS
MK
PC
PC
Interpret diagnostic tests to characterize anal incontinence and defecatory disorders and demonstrate knowledge of the following for each test:
Standard terminology, normal values, and test reliability, Variations in instrumentation and technique,
Indications, limitations, and cost-effectiveness, Results which require further testing.
MK, PC
Pelvic Organ Prolapse (UG)
Elicit a focused prolapse symptom history.
Discuss other pelvic floor symptoms and disorders and explain their relationship to pelvic organ prolapse.
Explain the most common symptoms associated with prolapse and explain the relationship between symptoms and anatomy.
Discuss various definitions of prolapse and normal support.
Discuss lower urinary tract symptoms associated with pelvic organ prolapse and the role and methods for reduction stress testing.
Discuss bowel symptoms associated with prolapse, including difficult defecation, splinting, or feeling of incomplete evacuation.
Discuss relationship of prolapse with sexual activity and function.
Perform a focused pelvic floor physical examination, assessing:
Neurologic status (pelvic floor and lower limb reflexes and sensation). Pelvic floor muscle and anal sphincter strength. Pelvic organ support
defects (identifying and quantifying all pelvic support defects using Pelvic Organ Prolapse Quantification (POP-Q) system. Urethral hypermobility.
Sign of stress incontinence (reduction stress test)
Describe factors that may affect severity of observed prolapse and alter POP-Q measures during examination (strain, supine vs. standing, etc.)
Describe techniques to identify enteroceles and perineal descent.
Non-surgical Treatment (UG)
Discuss non-surgical and surgical treatment options for symptomatic anterior, apical, and posterior prolapse.
Discuss role of pelvic floor physical therapy in management of prolapse.
List factors which impact successful pessary fitting for prolapse, including: stage, genital hiatus, uterus, etc.
Fit and manage prolapse pessaries.
Discuss the advantages and disadvantages of the following pessary types: Ring with and without support Donut, Gelhorn, Gehrung, Lever, Cube
Discuss the role of estrogen replacement therapy (systemic vs. local) in women using pessary for prolapse.
Explain how recommendations differ based on presence or absence of uterus.
Vesicovaginal, Urethrovaginal, and Ureterovaginal Fistulas (U) (UG)
Describe risk factors for genitourinary fistulas (urethrovaginal, vesicovaginal, ureterovaginal, colovesical) and urethral diverticula.
PC, ICS
PC, MK
MK
MK
MK
MK
MK
PC
MK
MK
MK
MK
MK, PC
PC
MK, PC
MK, PC
MK, PC
MK
Complete background study, hypothesis, feasibility, and plan for Thesis Project should be completed by the end of 1st 6 months. The thesis may be changed if completion
of an alternative acceptable project is feasible by early in the last 6 months of the fellowship. Projects should be discussed with Dr. Richter and deemed acceptable,
mentor(s) should be chosen and protocol draft and IRB application should be completed. Other research studies are expected to be performed during the duration of the
fellowship all requiring the above planning.
29
Urogynecology Fellow or three year Urology Fellow:
Acquired knowledge assignments for year 1 with completion expected during the second 6 months
Epidemiology and Impact of disease (U) (UG)
Urinary Incontinence Fecal Incontinence Defecatory dysfunction and Pelvic Organ Prolapse.
Epidemiology and Demographics of fistulas from childbirth injury.
Relationship of incontinence and prolapse to birth, aging, and neurologic disease.
Impact of all pelvic floor disorders on Quality of Life.
Know the disease specific and global health questionnaires use to evaluate them.
Urinary Tract Infection (U) (UG)
Obtain a pertinent patient history and diagnose urinary tract infection., (PC, ICS),
Distinguish pathophysiology, including host factors, for lower and upper urinary tract infections.
MK
Describe diagnostic methods and diagnostic criteria for the various types of urinary tract infections.
Describe techniques accuracy sensitivity specificity and interpretation of the following urine tests for primary and recurrent urinary tract
infection. Urine dipstick analysis, Urine analysis, Urine culture.
Describe the indications for the following tests for urinary tract infection. Cystourethroscopy, Upper tract imaging.
MK
MK
Describe evidence for urinary tract infection treatment options including the following; Single dose therapy, Short-term (3-day) therapy, Longer
treatment (7-10 days), Prophylactic treatment (daily versus coital), Non-microbial agents, probiotics, urine acidifiers.
Administer and assess efficacy of appropriate therapy for acute, chronic, and complicated urinary tract infections.
Overactive Bladder (U) (UG)
Cite indications techniques response rates and side effects of the following: Biofeedback, Bladder Training, Neuromodulation, Pharmacologic
agents including, Anticholinergics, Antispasmodics, Sedatives, Antidepressants, and Other evidenced based treatments.
MK
General Pelvic Floor Evaluation (UG)
Perform a focused pelvic floor examination including assessment of uterovaginal support pelvic muscle strength neurologic status and uterine
and ovarian size.
Describe the techniques needed to diagnose different pelvic floor disorders including urinary incontinence and subtypes of lower urinary tract
disorders, pelvic organ prolapsed and fecal incontinence using prevailing international terminology.
Evaluate for co-existing environmental factors or diseases which may impact patient selection or response to treatment.
Focused assessment of POP Q evaluation (UG)
(Lisa Pair CRNP FPMRS faculty),
List and Understand all causes of urinary incontinence due to both lower urinary tract dysfunction per se’ and that due to functional causes.
(U) (UG) (GR)
Urinary Incontinence (U) (UG)
Perform a focused pelvic floor physical examination assessing: Neurologic status (pelvic floor and lower limb reflexes and sensation), Pelvic floor
muscle and anal sphincter strength, Pelvic floor support defects – anterior apical and posterior, Urethral hyper-mobility, Structural anatomic and
congenital malformations, Sign of stress incontinence (stress test).
Complete Focused Assessment of Basic Urodynamics Evaluation (UG)
PC
Surgical Treatment of Urinary Incontinence (U) (UG)
Describe the indications intra and postoperative complications and success of the following continence procedures: Kelly plication Needle
suspension procedures (Pereyra Raz Stamey Gittes, Muzsnai),
MK, PC
30
PC, ICS
MK
PC
PC
MK, PBLI
MK, PC
PC
MK, PC, ICS
MK, SBC, PC
PC
PC, P, MK
Discuss differences in continence procedure success rates in women with and without urethral hypermobility.
MK
Discuss impact of concomitant prolapse surgery on continence procedure success rates.
MK
Pharmacological Treatment (U) (UG) (GR)
Describe lower urinary tract receptors and mediators (detrusor bladder neck urethra) and potential sites for pharmacologic manipulation to
treat various types of urinary incontinence.
List the following for each class of drug used to treat urinary incontinence listed in #3 below. Indications and contraindications, Safe and
effective dose, Published rates of effectiveness, Side effects and their prevalence, Rates of long-term continuation and compliance, Quality of
studies establishing success and complication rates, Costs,
Drugs Used to Treat Urinary Incontinence, Antimuscarinic agents, α-adrenergic agonists and antagonists, β-adrenergic agonists, Selective
norepinephrine and serotonin uptake inhibitors, Tricyclic antidepressants, Neurotoxins (botulinum capsaicin resiniferatoxin),
Fecal Incontinence Evaluation (UG) (GR)
Diagnostic Tests for Fecal Incontinence and Defecatory Disorders
Endoscopy including anoscopy, proctoscopy, and colonoscopy, Anal manometry, Anorectal sensory assessment, Measurement of rectal
compliance, Defecography/ evacuation proctography/dynamic fluoroscopy, Neurophysiologic studies (e.g., electromyography, sacral reflexes,
terminal motor latencies), Anal ultrasound, Levator and anal sphincter MRI, Fistulogram, Motility studies.
Evaluate co-existing factors or diseases which may direct treatment selection and response.
Complete Focused Assessment of Genitorectal Evaluation (UG) (Evaluator Dr. Richter or Ballard)
Surgical Treatment (UG)
Discuss the alternatives, risks, benefits, complications, success rates and levels of evidence for each of the following apical prolapse procedures.
Sacrocolpopexy (open, laparoscopic, robotic), Vaginal mesh procedures (absorbable, non-absorbable, biologics), Uterosacral suspension,
Sacrospinous ligament suspension, McCall’s culdeplasty, Illiococcygeous
suspension, Colpocleisis, Manchester operation, Other evidenced based procedures.
Discuss the alternatives, risks, benefits, complications, success rates, and levels of evidence for each of the following anterior prolapse
procedures.
Anterior colporrhaphy, Anterior vaginal repair with graft, Paravaginal repair, Other evidenced based procedures.
Discuss the alternatives, risks, benefits, complications, success rates, and
Levels of evidence for each of the following posterior prolapse procedures.
Posterior colporrhaphy, Defect-specific posterior repair, Trans-anal repair, Posterior repair with graft, Perineorrhaphy, Other evidenced based
procedures.
Complete Pig Lab simulated Laparoscopic Sacrocolpopexy (UG)
Complete Robotic SCP training Module (UG)
Rectovaginal Fistula (UG)
Describe risk factors for rectovaginal fistulas, including vaginal childbirth, operative vaginal delivery, episiotomy, pelvic radiation, inflammatory
bowel disease, neoplasm.
Describe appropriate techniques, imaging studies, and procedures to diagnose rectovaginal fistula, Fistulogram, Ultrasound.
MK
Complete Focused Assessment on Diagnostic Cystoscopy (U)
PC, MK, SBP,
ICS
MK, SBP, PBLI,
ICS
Should have completed: Options for Understanding Research Design and Statistics, (UAB courses or Excellence in Research). Completion of
this during year two is acceptable if a specific program can only be accomplished then.
Complete Focused Assessment of Retropubic and Transobturator slings
31
MK, PC, PBLI
PC,MK
PC,MK
PC
PC,MK,PBLI,SBP
MK, PC, PBLI
MK, PC, PBLI
MK, PC, PBLI
PC, SBP, MK
PC, SBP, MK
MK
MK, PC
Urogynecology Fellow or Three Year Urology Fellow:
Acquired knowledge assignments for year 2 with completion expected during the first 6 months
General Pelvic Floor Evaluation (UG)
Correlate findings on focused pelvic floor examination with the results of diagnostic testing to formulate a treatment plan.
Urinary Incontinence (U) (UG)
Perform and/or interpret the diagnostic tests listed below to characterize lower urinary tract disorders:
Simple single urodynamics, Multi-channel urodynamics including video-urodynamics, Urethral pressure profilometry, Leak point pressures,
Uroflowmetry (simple instrumented pressure flow studies), Urethral and anal sphincter electromyography, Neurophysiologic studies (e.g.
electromyography sacral reflexes and terminal motor latency), Endoscopy (cystoscopy urethroscopy), Imaging studies (e.g. fluoroscopy
ultrasound MRI), Pelvic floor muscle testing, Bladder cytology, Urinary microscopy and culture,
PC
Discuss each of the following as related to the diagnostic tests listed in #3 above. Standard terminology normal values and test reliability,
Variations in instrumentation and technique, Technical specifications of the equipment or instrumentation, Indications limitations and costeffectiveness, Results which require further testing.
MK
Complete Focused Assessment on Retropubic and Transobturator Sling (U) (UG)
Urogenital Fistulas (U) (UG)
Vesicovaginal, Urethrovaginal, and Ureterovaginal Fistulas
Describe alternative, risks, benefits, complications, success rates, and levels of evidence and techniques for the following procedures: Prolonged
bladder drainage, TransVaginal repair of Vescico Vaginal Fistulas, Abdominal (open and minimally invasive), transvesical, and vaginal,
Vesicovaginal fistula repairs, Vascular grafts (e.g., martius, omental), Ureteroneocystostomy, Psoas hitch, Boari flap, Transureteroureterostomy.
PC, SBP, MK
MK, PC, PBLI
Describe how timing of repair influences outcomes.
Describe postoperative care after genitourinary fistula and urethral diverticula repair: Postoperative bladder drainage, Antibiotics.
Rectovaginal Fistula (UG)
Describe operative technique to repair rectovaginal fistula and impact of location and etiology on technique.
Discuss postoperative management of rectovaginal fistula repair.
Congenital Anomalies (U) (UG)
Describe the normal embryology of Mullerian and ovarian development
Describe the pathogenesis of abnormal Mullerian development, including imperforate hymen, transverse vaginal septum, vaginal agenesis with
and without a uterus.
Evaluate and diagnose congenital anomalies of the urogenital tract. (MK)
Discuss the relationship between genital anomalies and renal/lower urinary tract anomalies.
Describe features of a patient’s history suggestive of a developmental anomaly of the urogenital tract.
Interpret the following tests to diagnose a urogenital anomaly, its etiology, and potential clinical implications: Ultrasound, Endocrinologic assay
(hormones), Karyotype assessment, CT or MRI, Endoscopic assessment (hysteroscopy, laparoscopy, cystoscopy, retrograde, pyelogram).
Understand appropriate non-surgical and surgical techniques to treat urogenital anomalies, including imperforate hymen, vaginal agenesis with
and without uterus, transverse vaginal septum, Mullerian anomalies.
Discuss appropriate timing and indications for gonadectomy.
Counsel patients and their families about the impact of urogenital anomalies on reproduction and timing of reconstruction.
MK
PC
MK, PC
32
MK, PC, SBL
MK, PC
MK
MK
MK
MK
MK, PC
PC
MK
ICS
Sensory Disorders (U)
Discuss the proposed theories and the levels of evidence regarding the pathophysiology of painful bladder syndrome.
Diagnose painful bladder syndrome using prevailing international definitions and urinary diaries.
MK, PBLI
Explain the role of diet on the development or exacerbation of painful bladder symptoms.
MK
Perform and interpret cystourethroscopy, cytology, and bladder biopsy findings under anesthesia for painful bladder syndrome
PC
Describe the technique, indications, limitations, side effects and level of evidence for each of the following treatments: Hydrodistention of the
bladder under anesthesia, Bladder instillation, Physical and behavioral therapy, Systemic therapy including, Immunosuppressive agents, such as
corticosteroids, Antihistamines, Anti-inflammatory agents, Sodium pentosan polysulfate, Comprehensive pain management, Endoscopic surgical
procedures, Surgical procedures, Bladder augmentation procedures, Urinary diversions, Other evidenced based therapies
MK, PC, PBLI
Neuro Urology (U)
Describe the pathophysiology of neurologic conditions which affect the bladder and lower urinary tract. (MK)
Elicit a complete neuro-urologic history elucidating relevant neurologic conditions and any gross motor and sensory deficits.
MK
Perform an accurate neurologic examination, including assessment of lower limb reflexes, sensory and motor function, perineal sensation and
reflexes, and pelvic floor and anal sphincter muscle strength.
Appropriately evaluate bladder storage and voiding function using urodynamic testing and prevailing international terminology.
PC
Describe the pathophysiology of the risks associated with neurogenic lower urinary tract dysfunction.
Assess the risks of bladder dysfunction to upper urinary tract function.
Formulate a management plan to protect the upper urinary tract from neurogenic bladder dysfunction.
MK
PC
PC
Discuss the pathophysiology and management of autonomic dysreflexia.
Recognize and manage lower urinary symptoms related to neurologic disorders.
MK
PC
Complete Focused Assessment on Retropubic and Transobutrator Mid-urethral slings.
PC, MK,SBP,ICS
33
PC
PC
PC
Urogynecology Fellow or Three Year Urology Fellow:
Acquired knowledge assignments for year 2 with completion expected during the second 6 months
Know the Embryological development of the genitor-urinary and colorectal structures and correlate anomalies of these structures to
embryological defects. (U) (UG)
Surgical Treatment of Urinary Incontinence (U) (UG)
Cite published success and complication rates for each continence procedure, quality of studies and level of evidence.
Discuss differences in success rates of primary and secondary continence procedures.
MK, PC
Complete Focused Evaluations (UG)
High Uterosacral Intraperitaneal Suspension
Michigan Sacrospinous Suspension
Laparoscopic sarcolpopexy
Ureteral Stint placement and Retrograde Pyelogram
Vaginal reconstruction repair of total prolapsed (Procidentia a total vault prolapsed)
PC,MK,
PBLI,P,ICS
Urogenital Fistulas (U) (UG)
Vesicovaginal, Urethrovaginal, and Ureterovaginal Fistulas
Treat genito-urinary fistulas and urethral diverticula.
Understand the benefits and short comings and interpret the results of selected tests to diagnose genitourinary fistulas and diverticula.
Tampon test, Cystourethroscopy, CT Urogram, MRI, Ultrasound, Retrograde pyelograms.
PC
34
PBLI
MK
MK, PC
Urogynecology Fellow:
Acquired knowledge assignments for year 3 with completion expected during the first 6 months
Thesis Project (see page 17)
Write publishable scientific thesis. Must be in a form fulfill publication criteria for one of the following Journals:
Obstetrical and Gynecology
Journal of Urology
American Journal of Obstetrics and Gynecology
New England Journal of Medicine
Study aims, Hypothesis, Study Plan
Study population and generalizability of findings
Inclusion and exclusion criteria
Appropriate study design to answer specific aims
Experimental, randomized, analytical, prospective/retrospective, observational
Types of bias (selection, information, confounding)
Appropriateness of control group
Statistical (study) power
Outcome measures
Analysis of results (statistical tests and interpretations).
Conclusions justified by findings and relevant to hypothesis.
Participate in a problem based or system based learning quality improvement activity whereby a problem is identified and investigated, a
potential solution or several solutions are proposed, then put into place with follow up investigation.
The following GMS Health Stream Web Based or Formal Lecture Based programs with a passing grade on Post-test Evaluations should be
completed. (U) (UG) (R)
Quality/ Patient Safety
Professionalism with staff and patients (AIDET)
Information System – Rules of Behavior
Safety and Clinical Competency 2011
Corporate Compliance
Confidentiality
Conflict and Disclosures
Stress and Substance Abuse
Sleep Deprivation (Prevention, Recognition and Responsibility
Diversity Training (Cultural, Race, Ethnic)
Attend Obstetrics and Gynecology Ethics Grand Rounds held quarterly
Complete Modified Focus Assessments (UG)
Vaginal repair of Vesicovaginal Fistula
Vaginal Repair of Recto Vaginal Fistula (UG)
Abdominal repair of Vesicovaginal Fistula (U) (UG)
35
MK, PBLI, SBP, ICS
PBC, P, SBP, MK, ICS
P, MK, SBP, ICS
PC, MK, ICS
PC, MK, ICS
PC, MK, ICS
Urologist (2 year program):
Acquired knowledge assignments for year 1 with completion expected during the first 6 months
Pelvic Floor Anatomy (UG)
Demonstrate knowledge of pelvic anatomy, including genital, urinary, colorectal, and musculoskeletal elements.
Describe the vascular and nerve supply to each of the pelvic organs and structures, including the external genitalia, uterus, kidney, urethra,
bladder, and recto-sigmoid.
Explain the normal anatomic supports of the vagina, rectum, bladder, urethra, and uterus, including the bony pelvis, pelvic floor nerves and
musculature, and connective tissue.
Describe the inter-relationships and function of the pelvic organs and support mechanisms.
Describe the anatomy, borders, and content of the pelvic and retroperitoneal spaces.
MK
Describe the anatomy of the anterior abdominal wall.
Describe the vascular and nerve supply to the urethral and anal sphincter mechanisms.
Describe and interpret normal and abnormal reproductive and urinary tract anatomy.
Pelvic Floor Physical (UG)
Describe the normal function of the lower urinary tract during storage and micturition and the mechanisms responsible for urinary continence.
MK
MK
MK
MK
Describe the physiology of colorectal function.
Describe normal utero-vaginal physiology and function.
Overactive Bladder(U) (UG)
Cite the prevailing international definitions of urinary frequency urgency nocturia and overactive bladder syndrome.
MK
MK
MK, PBLI
Discuss the indications characteristic findings and limitations of the following methods that may be used to diagnose overactive bladder
syndrome: Clinical symptoms, Urinary diary, Urine, urethral cervical culture, Cystometry, Cystourethroscopy,
General Pelvic Floor Evaluation (UG)
Elicit a comprehensive medical history including a directed history that identifies all pelvic floor disorders, their type and severity.
Urinary Incontinence (U) (UG)
Perform a directed pelvic floor history including appropriate use of prevailing international terminology related to the signs and symptoms of
urinary incontinence and lower urinary tract function and evaluation of:
Urinary symptom severity and bother, including use of urinary diaries pad tests and condition-specific bother and quality of life questionnaires
Past medical obstetrical and surgical histories
Structural anatomic and congenital malformations,
Current medications and their effects on urinary symptoms,
Other organ systems including the nervous system and their effects on lower urinary tract function,
Prior treatments and patient’s response,
Surgical Treatment of Urinary Incontinence (U) (UG)
Assist in and perform surgical procedures for stress incontinence which are felt to be applicable today (mid-urethral sling retropubic and
transobutrator burch procedure and understand the basic techniques of the commonly performed procedures in the past (MMK Stamey Raz
Pereyra and modifications).
Describe the indications intra and postoperative complications and success of the following continence procedures:
Periurethral bulk injections, Retropubic urethropexy (Marshall-Marchetti-Krantz, Burch, and paravaginal defect repair), Sling procedures, Fascial
(fascia lata, rectus fascia), Synthetic, Retropubic, Transobutrator,
Identify evaluate and know management of complications associated with continence surgery.
Discuss role of urodynamic testing when planning continence surgery.
MK
36
MK
MK
MK
MK
PC
MK, PC
PC
MK, PC
MK, PC
MK
Discuss alternatives advantages disadvantages and evidence for prophylactic continence procedures at the time of vaginal and abdominal
prolapse surgery in stress continent women.
Complete Focused Assessment on Diagnostic Cystoscopy (U)
Behavioral Treatment (GR)
Describe each of following behavioral treatments used to treat urinary incontinence.
Timed voiding, Bladder training, Biofeedback, Pelvic floor muscle training, Electrical stimulation, Other evidenced based treatments.
MK, PBLI, ICS
Counsel patients on each of the behavioral interventions listed above specifically: (MK, PC, PBLI, ICS)
List indications and contraindications, Cite published effectiveness rates, Explain frequency and types of side effects, Discuss long-term
continuation and compliance rates, Evaluate the level of evidence for success and complication rates, List costs of treatment regimens.
Functional Treatment (GR)
Describe the following functional factors related to urinary incontinence:
Mobility issues, Fecal impaction, Dementia, Hyperglycemia, Infection, Nocturnal polyuria, Medications, Sedatives, Hypnotics, Diuretics,
Antidepressants.
MK, PC, PBLI, ICS
Discuss the role and risks of each of the following functional interventions in the management of urinary incontinence.
Fluid management, including evening restrictions, Change of pharmacologic agents or timing of their use (diuretics), Avoid nocturnal diuresis
with decompression, CPAP, Optimize control of allergies, bronchitis, and chronic cough, Modification the environment (e.g., use of a bedside
commode), Optimize bowel function and minimize constipation and fecal impaction, Modification of clothing to compensate for decreased
dexterity, Intermittent self-catheterization, Absorbent products, Pessaries or tampons, Other evidenced based treatments.
Counsel patients regarding hazards and limitations of chronic indwelling catheters.
MK
Fecal Incontinence Evaluation (UG) (GR)
Elicit a comprehensive pelvic floor history including the following:
Symptoms associated with fecal incontinence such as diarrhea, fecal urgency constipation or defecatory problems, Prevailing international
terminology for anal incontinence, Determine fecal incontinence duration and severity, precipitating factors, and lifestyle modifications,
Evaluate past medical, obstetrical, and surgical histories, Structural, anatomic and congenital malformations, Evaluate current medications and
their effect on colorectal function, Evaluate other organ systems including neurologic, lower urinary tract and pelvic support, and their possible
effects of the colorectal system, Determine psychosocial and psychosexual effects of fecal incontinence.
Determine all prior therapies and responses, Perform a focused physical examination including:
Neuromuscular examination with assessment of pelvic floor muscle and anal sphincter strength, pelvic floor reflexes, and perineal and anal
sensory function,
PC
Identification of anal fistula, fissures, or scarring, perineal descent, rectal prolapse, hemorrhoids, tumor, and anal sphincter disruptions,
Interpret diagnostic tests listed in #4 below to characterize anal incontinence and defecatory disorders and demonstrate knowledge of the
following for each test:
Standard terminology, normal values, and test reliability, Variations in instrumentation and technique, Indications, limitations, and costeffectiveness, Results which require further testing,
MK, PC
Pelvic Organ Prolapse (UG)
Elicit a focused prolapse symptom history.
Discuss other pelvic floor symptoms and disorders and explain their relationship to pelvic organ prolapse.
Explain the most common symptoms associated with prolapse and explain the relationship between symptoms and anatomy.
Discuss various definitions of prolapse and normal support.
Discuss lower urinary tract symptoms associated with pelvic organ prolapse and the role and methods for reduction stress testing.
Discuss bowel symptoms associated with prolapse, including difficult defecation, splinting, or feeling of incomplete evacuation.
Discuss relationship of prolapse with sexual activity and function.
PC, ICS
37
PC, MK, SBP, ICS
MK
MK
MK, PC, ICS
PC
PC, MK
MK
MK
MK
MK
MK
Perform a focused pelvic floor physical examination, assessing: Neurologic status (pelvic floor and lower limb reflexes and sensation), Pelvic
floor muscle and anal sphincter strength, Pelvic organ support defects (identifying and quantifying all pelvic support defects using Pelvic Organ
Prolapse Quantification (POP-Q) system, Urethral hypermobility, Sign of stress incontinence (reduction stress test)
Describe factors that may affect severity of observed prolapse and alter POP-Q measures during examination (strain, supine vs. standing, etc.).
PC
Describe techniques to identify enteroceles and perineal descent.
Non-surgical Treatment (UG)
Discuss non-surgical and surgical treatment options for symptomatic anterior, apical, and posterior prolapse.
Discuss role of pelvic floor physical therapy in management of prolapse.
List factors which impact successful pessary fitting for prolapse, including: stage, genital hiatus, uterus, etc.
Fit and manage prolapse pessaries.
Discuss the advantages and disadvantages of the following pessary types: Ring with and without support, Donut, Gelhorn, Gehrung, Lever, Cube.
Discuss the role of estrogen replacement therapy (systemic vs. local) in women using pessary for prolapse.
Explain how recommendations differ based on presence or absence of uterus.
Urogenital Fistulas (U) (UG)
Vesicovaginal, Urethrovaginal, and Ureterovaginal Fistulas
Describe risk factors for genitourinary fistulas (urethrovaginal, vesicovaginal, ureterovaginal, colovesical) and urethral diverticula.
MK
MK
Sensory Disorders (U)
Discuss the proposed theories and the levels of evidence regarding the pathophysiology of painful bladder syndrome.
Diagnose painful bladder syndrome using prevailing international definitions and urinary diaries.
Explain the role of diet on the development or exacerbation of painful bladder symptoms.
Perform and interpret cystourethroscopy, cytology, and bladder biopsy findings under anesthesia for painful bladder syndrome.
Describe the technique, indications, limitations, side effects and level of evidence for each of the following treatments. Hydrodistention of the
bladder under anesthesia, Bladder instillation, Physical and behavioral therapy, Systemic therapy including, Immunosuppressive agents, such as
corticosteroids, Antihistamines, Anti-inflammatory agents, Sodium pentosan polysulfate, Comprehensive pain management, Endoscopic surgical
procedures, Surgical procedures, Bladder augmentation procedures, Urinary diversions, Other evidenced based therapies
Neuro Urology (U)
Describe the pathophysiology of neurologic conditions which affect the bladder and lower urinary tract.
Elicit a complete neuro-urologic history elucidating relevant neurologic conditions and any gross motor and sensory deficits.
Perform an accurate neurologic examination, including assessment of lower limb reflexes, sensory and motor function, perineal sensation and
reflexes, and pelvic floor and anal sphincter muscle strength.
Appropriately evaluate bladder storage and voiding function using urodynamic testing and prevailing international terminology. (PC)
MK, PBLI
MK
MK
MK, PC
PC
MK, PC
MK, PC
MK, PC
MK
PC
MK
PC
MK, PC, PBLI
MK
PC
PC
Describe the pathophysiology of the risks associated with neurogenic lower urinary tract dysfunction. (MK)
MK
Assess the risks of bladder dysfunction to upper urinary tract function. (PC)
PC
Formulate a management plan to protect the upper urinary tract from neurogenic bladder dysfunction. (PC)
PC
Discuss the pathophysiology and management of autonomic dysreflexia. (MK)
MK
Recognize and manage lower urinary symptoms related to neurologic disorders. (PC)
PC
Complete background study, hypothesis, feasibility, and plan for Thesis Project should be completed by the end of 1st 6 months. The thesis may be changed if completion
of an alternative acceptable project is feasible by early in the last 6 months of the fellowship. Projects should be discussed with Dr. Richter and deemed acceptable,
mentor(s) should be chosen and protocol draft and IRB application should be completed. Other research studies are expected to be performed during the duration of the
fellowship all requiring the above planning.
38
Urologist:
Acquired knowledge assignments for year 1 with completion expected during the second 6 months
Epidemiology and Impact of disease (U) (UG)
Urinary Incontinence Fecal Incontinence Defecatory dysfunction and Pelvic Organ Prolapse, Epidemiology and Demographics of fistulas from
childbirth injury, Relationship of incontinence and prolapse to birth, aging, and neurologic disease, Impact of all pelvic floor disorders on Quality
of Life, Know the disease specific and global health questionnaires use to evaluate them,
MK
Know the Embryological development of the genitor-urinary and colorectal structures and correlate anomalies of these structures to
embryological defects (U) (UG)
Urinary Tract Infection(U) (UG)
Obtain a pertinent patient history and diagnose urinary tract infection.
Distinguish pathophysiology, including host factors, for lower and upper urinary tract infections.
MK, PC
Describe diagnostic methods and diagnostic criteria for the various types of urinary tract infections.
Describe techniques accuracy sensitivity specificity and interpretation of the following urine tests for primary and recurrent urinary tract
infection: Urine dipstick analysis, Urine analysis, Urine culture.
Describe the indications for the following tests for urinary tract infection: Cystourethroscopy, Upper tract imaging.
Describe evidence for urinary tract infection treatment options including the following: Single dose therapy, Short-term (3-day) therapy, Longer
treatment (7-10 days), Prophylactic treatment (daily versus coital), Non-microbial agents, probiotics, urine acidifiers.
Administer and assess efficacy of appropriate therapy for acute, chronic, and complicated urinary tract infections.
Overactive Bladder (U) (UG)
Cite indications techniques response rates and side effects of the following: Biofeedback, Bladder Training, Neuromodulation, Pharmacologic
agents including, Anticholinergics, Antispasmodics, Sedatives, Antidepressants, and Other evidenced based treatments.
General Pelvic Floor Evaluation (UG)
Elicit a comprehensive medical history including a directed history that identifies all pelvic floor disorders, their type and severity.
Perform a focused pelvic floor examination including assessment of uterovaginal support pelvic muscle strength neurologic status and uterine
and ovarian size.
Correlate findings on focused pelvic floor examination with the results of diagnostic testing to formulate a treatment plan.
Describe the techniques needed to diagnose different pelvic floor disorders including urinary incontinence and subtypes lower urinary tract
disorders, pelvic organ prolapsed and fecal incontinence using prevailing international terminology.
Evaluate for co-existing environmental factors or diseases which may impact patient selection or response to treatment.
Focused assessment of POP Q evaluation (Lisa Pair CRNP FPMRS faculty) (UG)
List and Understand all causes of urinary incontinence due to both lower urinary tract dysfunction per SE’ and that due to functional causes.
(UG) (GR)
Urinary Incontinence (U) (UG)
Perform a focused pelvic floor physical examination assessing: Neurologic status (pelvic floor and lower limb reflexes and sensation), Pelvic floor
muscle and anal sphincter strength, Pelvic floor support defects – anterior apical and posterior, Urethral hyper-mobility, Structural anatomic and
congenital malformations, Sign of stress incontinence (stress test),
Complete Focused Assessment of Basic Urodynamics Evaluation. (Lisa Pair CRNP FPMRS faculty) (UG)
Surgical Treatment of Urinary Incontinence (U) (UG)
Describe the indications intra and postoperative complications and success of the following continence procedures.
MK
MK
39
PC, ICS
MK
PC
MK
PC
MK, PBLI
PC
PC
PC
MK, PC
PC
MK, SBC, PC
PC
PC, P, MK
MK, PC
Discuss differences in continence procedure success rates in women with and without urethral hypermobility, (Kelly placation Needle
suspension procedures (Pereyra Raz Stamey Gittes, Muzsnai).
MK
Discuss impact of concomitant prolapse surgery on continence procedure success rates.
Complete Focused Assessment on Retropubic and Transobutrator Mid-urethral slings. (U) (UG)
Pharmacological Treatment (U) (UG) (GR)
Describe lower urinary tract receptors and mediators (detrusor bladder neck urethra) and potential sites for pharmacologic manipulation to
treat various types of urinary incontinence.
List the following for each class of drug used to treat urinary incontinence listed in #3 below: Indications and contraindications, Safe and
effective dose, Published rates of effectiveness, Side effects and their prevalence, Rates of long-term continuation and compliance, Quality of
studies establishing success and complication rates, Costs, Drugs Used to Treat Urinary Incontinence, Antimuscarinic agents, α-adrenergic
agonists and antagonists, β-adrenergic agonists, Selective norepinephrine and serotonin uptake inhibitors, Tricyclic antidepressants,
Neurotoxins (botulinum capsaicin resiniferatoxin).
Fecal Incontinence Evaluation (UG)
Evaluate co-existing factors or diseases which may direct treatment selection and response.
Complete Focused Assessment of Genitorectal Evaluation (Evaluator Dr. Richter or Ballard) (UG)
Surgical Treatment (UG)
Discuss the alternatives, risks, benefits, complications, success rates and levels of evidence for each of the following apical prolapse procedures:
Sacrocolpopexy (open, laparoscopic, robotic) Vaginal mesh procedures (absorbable, non-absorbable, biologics) Uterosacral suspension,
Sacrospinous ligament suspension, McCall’s culdeplasty, Illiococcygeous suspension, Colpocleisis, Manchester operation, Other evidenced based
procedures
Discuss the alternatives, risks, benefits, complications, success rates, and levels of evidence for each of the following anterior prolapse
procedures: Anterior colporrhaphy, Anterior vaginal repair with graft, Paravaginal repair, Other evidenced based procedures
Discuss the alternatives, risks, benefits, complications, success rates, and levels of evidence for each of the following posterior prolapse
procedures: Posterior colporrhaphy, Defect-specific posterior repair, Trans-anal repair, Posterior repair with graft, Perineorrhaphy, Other
evidenced based procedures
Complete Pig Lab simulated Laparoscopic Sacrocolpopexy (UG)
Ureteral Stint placement (U)
Retrograde Pyelogram Rectovaginal Fistula (U)
Describe risk factors for rectovaginal fistulas, including vaginal childbirth, operative vaginal delivery, episiotomy, pelvic radiation, inflammatory
bowel disease, neoplasm.
Describe appropriate techniques, imaging studies, and procedures to diagnose rectovaginal fistula, Fistulogram, Ultrasound
Should have completed required (Progress in Research Design and Statistics)
MK
PC, MK, SBP, ICS
MK
40
MK, PC, PBLI
PC
PC,MK,PBLI,P
MK, PC, PBLI
MK, PC, PBLI
MK, PC, PBLI
PC, SBP, MK
MK
MK
MK, PC
Urologist:
Acquired knowledge assignments for year 2 with completion expected during the first 6 months
General Pelvic Floor Evaluation (UG)
Correlate findings on focused pelvic floor examination with the results of diagnostic testing to formulate a treatment plan.
Urinary Incontinence (U) (UG)
Perform and/or interpret the diagnostic tests listed below to characterize lower urinary tract disorders: Simple single urodynamics, Multichannel urodynamics including video-urodynamics, Urethral pressure profilometry, Leak point pressures, Uroflowmetry (simple instrumented
pressure flow studies), Urethral and anal sphincter electromyography, Neurophysiologic studies (e.g. electromyography sacral reflexes and
terminal motor latency), Endoscopy (cystoscopy urethroscopy), Imaging studies (e.g. fluoroscopy ultrasound MRI), Pelvic floor muscle testing,
Bladder cytology, Urinary microscopy and culture,
Discuss each of the following as related to the diagnostic tests listed in #3 above: Standard terminology normal values and test reliability,
Variations in instrumentation and technique, Technical specifications of the equipment or instrumentation, Indications limitations and costeffectiveness, Results which require further testing,
Surgical Treatment of Urinary Incontinence (U) (UG)
Cite published success and complication rates for each continence procedure, quality of studies and level of evidence.
Discuss differences in success rates of primary and secondary continence procedures.
Complete Robotic SCP training Module (UG)
Complete Focused Evaluations (UG)
High Uterosacral Intraperitaneal Suspension
Michigan Sacrospinous Suspension
Vaginal reconstruction repair of total prolapsed (Procidentia a total vault prolapsed)
Urogenital Fistulas Vesicovaginal, Urethrovaginal, and Ureterovaginal Fistulas (U) (UG)
Treat genito-urinary fistulas and urethral diverticula.
Understand the benefits and short comings and interpret the results of selected tests to diagnose genitourinary fistulas and diverticula: Tampon
test, Cystourethroscopy, CT Urogram, MRI, Ultrasound, Retrograde pyelograms.
PC
Describe alternative, risks, benefits, complications, success rates, and levels of evidence and techniques for the following procedures: Prolonged
bladder drainage, TransVaginal repair of Vescico Vaginal Fistulas, Abdominal (open and minimally invasive), transvesical, and vaginal
vesicovaginal fistula repairs, Vascular grafts (e.g., martius, omental), Ureteroneocystostomy, Psoas hitch, Boari flap, Transureteroureterostomy
MK, PC, PBLI
Describe how timing of repair influences outcomes.
Describe postoperative care after genitourinary fistula and urethral diverticula repair: Postoperative bladder drainage, Antibiotics
Congenital Anomalies (U) (UG)
Describe the normal embryology of Mullerian and ovarian development.
Describe the pathogenesis of abnormal Mullerian development, including imperforate hymen, transverse vaginal septum, and vaginal agenesis
with and without a uterus.
Evaluate and diagnose congenital anomalies of the urogenital tract.
Discuss the relationship between genital anomalies and renal/lower urinary tract anomalies.
Describe features of a patient’s history suggestive of a developmental anomaly of the urogenital tract.
Interpret the following tests to diagnose a urogenital anomaly, its etiology, and potential clinical implications: Ultrasound, Endocrinologic assay
(hormones), Karyotype assessment, CT or MRI, Endoscopic assessment (hysteroscopy, laparoscopy, cystoscopy, retrogradepyelogram).
Understand appropriate non-surgical and surgical techniques to treat urogenital anomalies, including imperforate hymen, vaginal agenesis with
and without uterus, transverse vaginal septum, Mullerian anomalies.
MK
PC
MK
41
MK, PC, SBL
MK
PBLI
MK
PC, SBC, MK
PC,MK, SBP, PBLI,P
ICS
PC
MK, PC
MK
MK
MK
MK
MK, PC
PC
Discuss appropriate timing and indications for gonadectomy.
MK
Understand the counseling of patients and their families about the impact of urogenital anomalies on reproduction and timing of
reconstruction.
ICS
Thesis Project (see page 17)
Write publishable scientific thesis. Must be in a form fulfill publication criteria for one of the following Journals: Obstetrical and Gynecology,
Journal of Urology, American Journal of Obstetrics and Gynecology, New England Journal of Medicine.
MK, PBLI, SBP, ICS
Study aims: Study population and generalizability of findings, Inclusion and exclusion criteria, Appropriate study design to answer specific aims
Experimental, randomized, analytical, prospective/retrospective, observational, Types of bias (selection, information, confounding)
Appropriateness of control group, Statistical (study) power, Outcome measures, Analysis of results is appropriate (statistical tests and
interpretations), Conclusions justified by findings and relevant to hypothesis.
Participate in a problem based or system based learning quality improvement activity whereby a problem is identified and investigated, a
potential solution or several solutions are proposed, then put into place with follow up investigation (U) (UG) (R)
Perform the following GMS Health Stream Web Based or Formal Lecture Based programs with a passing grade on Post-test Evaluations. (U)
(UG) (R)
Quality/ Patient Safety, Professionalism with staff and patients (AIDET), Information System – Rules of Behavior, Safety and Clinical, Competency
20111, Corporate Compliance, Confidentiality, Conflict and Disclosures, Stress and Substance Abuse, Sleep Deprivation (Prevention, Recognition
and Responsibility Diversity Training (Cultural, Race, Ethnic), Attend Obstetrics and Gynecology Ethics Grand Rounds held quarterly.
MK,ICS,PBLI,SBP,P
42
PBC, P, SBP, MK, ICS
MK, SBP, ICS, P
Urologist:
Acquired knowledge assignments for year 2 with completion expected during the second 6 months
Complete Focused Evaluations Laparoscopic sacrocolpopexy
Rectovaginal Fistula
Describe operative technique to repair rectovaginal fistula and impact of location and etiology on technique.
Discuss postoperative management of rectovaginal fistula repair.
Complete Modified Focus Assessments
Vaginal repair of Vesico Vaginal Fistula
Vaginal Repair of Rectovaginal Fistula
Abdominal repair of Vesicovaginal Fistula
Thesis Project should be complete during this 6 month period
43
PC,MK,PBLI,ICS,P
MK, PC
MK, PC
PC, MK, ICS
PC, MK, ICS
PC, MK, ICS
Milestones Topics
Patient Care:
General Pelvic Floor Evaluation
UI and Overactive Bladder Treatment
Anal Incontinence & Defecatory Dysfunction Treatment
POP Treatment
Urogental Fistula & Urethral Diverticula Treatment
Painful Bladder Syndrome Treatment
UTI
Medical Knowledge:
Pelvic Floor Anatomy & Physiology
UI and Overactive Bladder Treatment
Anal Incontinence & Defecatory Dysfunction Treatment
POP Treatment
Urogental Fistula & Urethral Diverticula Treatment
Painful Bladder Syndrome Treatment
UTI
Neuro Urology
System Based Practice:
Computer Systems
Health Care Economics
Works & Coordinates Patient Care Effectively in Various Health Care Delivery setting & system
44
XII. Research Requirements
Oral Examination: Thesis
A thesis is required by the Division of Female Pelvic Medicine and Reconstructive Surgery. The thesis will be
reviewed by the committee for acceptability, presented to the faculty and fellows in FPMRS and Thesis
Committee at UAB, and defended. Approval by the Committee and FPMRS Division Faculty is a requirement for
entrance to the Oral Board Examination and Board approval is necessary for certification. The thesis need not
have been published or accepted for publication at the time of submission for the Oral Board Examination.
Acceptance of a thesis for publication by a refereed journal does not guarantee acceptance of the thesis for the
oral examination (Appendix C).
Appendix C: Thesis
The following information is provided to allow the candidate to see the subspecialty thesis requirements that are
in effect for the oral examinations in MFM, REI and Gyn Oncology and for FPMRS. Candidates are responsible for
preparing a thesis that meets the requirements for the year they are applying to take the oral examination.
Preparation
1. Format: The format of the thesis must comply with the instructions for authors for one of the following
journals: (1) American Journal of Obstetrics and Gynecology; (2) The New England Journal of Medicine; (3)
Obstetrics and Gynecology, (4) Journal of Urology, (5) Urology, (6) Neurology and Urodynamics and (7) Female
Pelvic Medicine and Reconstructive Surgery. The chosen format must be clearly identified on the cover page of
the manuscript. The manuscript may not exceed 30 pages in length, and the pages must be numbered. The thesis
must be type-written in 12 point type, single-spaced, and double-sided on standard 8 1/2 x 11 paper. Reprints of
published manuscripts are not acceptable. The applicant must be the sole or principal investigator and should be
the only author listed on the manuscript. Do not list co-authors, institutions, or acknowledgments. No more than
one thesis may be submitted.
2. Subject Matter: The subject matter should clearly relate to the area of Female Pelvic Medicine and
Reconstructive Surgery.
3. Research: The thesis may report a clinical, translational, or basic science based research project performed
during the fellowship period. A review of work performed by others is not acceptable.
4. IRB Approval: All research involving humans and animals must be reviewed and approved by the human or
animal institutional review boards (IRBs) of the sponsoring institution. If the research is considered to be exempt
from IRB approval, a statement from the IRB to that effect must be included with the thesis.
5. Thesis Content: The thesis must be a scholarly effort that most often should include the following sections:
a. Abstract: A concise statement of the work performed limited to 300 words;
b. Introduction: A short summary of the pertinent background and reasons for the project, as well as, when
appropriate, a testable hypothesis and a rationale for the hypothesis;
c. Methodology: If the thesis is based on bench research, a short description of the techniques used, including the
quality control of the methods, must be included. If the thesis is based on clinical research, a description of the
study and control groups and their appropriateness, as well as a power analysis is required;
d. Statistical Approach: A description of the analyses performed must be included, and support of the chosen
statistical techniques will be part of the defense of thesis during the oral examination.
e. Discussion: Pertinent discussion and significance of the study, including an appropriate review of the literature
and justification of the conclusion(s) reached must be included;
f. Conclusions: A short summary of results based on the findings of the study must be included; and
g. References: Appropriate references must be included. The pages listing the references should be counted in
the 30 page limit.
6. Unacceptable Papers: The following are not acceptable for a Fellow’s thesis:
a. book chapters,
b. clinical case reports,
c. descriptive series,
d. systemic reviews and meta-analyses
45
e. cost-efficiency or cost-effective analyses
f. results of patient surveys
7. Thesis Defense: As above during the last 6 months of Fellowship and during the oral examination, the
candidate may be asked one or all of the following questions. Additional questions may be asked which are not
listed in this outline.
a. Hypothesis
1) What were the study objectives?
2) What was the population studied?
3) What was the population to which the investigators intended to apply their findings?
b. Design of the investigation
1) Was the study an experiment, case control study, randomized clinical trial, planned observations, or a
retrospective analysis of records?
2) Were there possible sources of sample selection bias?
3) How comparable was the control group?
4) What was the statistical power of the study?
5) Was the design of the study appropriate for the hypothesis to be tested?
c. Observations
1) Were there clear definitions of the terms used (i.e., diagnostic criteria, inclusion criteria, measurements made
and outcome variables)?
2) Were the observations reliable and reproducible?
3) What were the sensitivity, specificity and predictive values of the methods?
d. Presentation of findings
1) Were the findings presented clearly, objectively, and in sufficient detail?
2) Were the findings internally consistent (i.e., did the numbers add up properly and could the different tables be
reconciled, etc).
Fellows will generally perform and or participate in several other studies during their fellowship. They may
choose to serve as a mentor to residents or medical students, but this would be a special circumstance where the
fellow is specifically over-seeing a project where the mentee has an interest in the field.
All proposed projects will be expected to pass through the phases of protocol development:
1. Concept outline:
A brief summary of the project overall goals should be organized as: Title, Hypotheses, Target population,
Study design, Primary outcome, Second outcome(s), Clinical significance, Feasibility, Proposed statistical
approach. This concept will be presented to the Fellowship Research Group for comments, advice.
2. Proposal:
This is an extended (usually less than 6 pages) explanation of the protocol. This should include the
following sections: Title, Potential collaborators as co-investigators, Brief introduction, Hypothesis, Aims,
Significance, Approach (to include - Study design, methods, procedure, and materials), Statistical
approach (to include - sample size/power analysis, evaluation of outcomes), Feasibility, Timeline, and
Plan for personnel/funding.
46
Statistical resources: If department statistical effort is to be sought, it will need to be presented to the
department Center for Research in Women’s Health (CRWH) over-sight committee and prioritized. If you plan to
seek statistical support through the Center for Clinical and Translational Sciences (CCTS), the fellow will meet with
a biostatistician during a twice monthly biostatistics clinic for statistical over-sight. This biostatistician will be a
designated investigator of your study/trial. The IRB approval process will be over-seen directly by the fellow with
input and over-sight by one of the Urogynecology division’s nurse managers (Ms Alice Howell or Velria Willis).
Fellows will be responsible for completion of all initial review, renewals, amendments, etc for each project. A
faculty mentor will give guidance for these studies as well. It is ideally expected that all projects be completed
and written by the end of your fellowship.
A research instruction and policy manual has been developed by Dr. Richter and research staff, Allie
Howell and Velria Willis and includes basic references to research design and statistics as well as UAB IRB
and conflict of interest policies. This manual will be reviewed in detail at the fellowship orientation that is
held during the first week of fellowship.
47
XIII. Academic and Service Portfolio
(Items in italics will be monitored and summaries provided by the Coordinator)
1. CV
2. Credentialing
3. Contracts
4. HealthStream
5. Learning Bibliography
6. Manuscripts
7. Research Proposals/Projects
8. Research Report from Dr. Richter
9. Article Reviews
10. Surgical Case List in ACGME format
11. PA OB/GYN Lecture, Conferences or lecture presentations, fellows’ conference, resident and student
conference and lecture, grand rounds, presentation’s at local or national meetings.
12. Scholar Activities/ Article Reviews
13. Duty Hours
14. Evaluations
a. Rotation Evaluations by Faculty
b. Clinical Focused Assessments
c. Surgical Focused Assessments
d. Presentation Evaluations
e. Global Competency Evaluations: student, patient, health care professionals, nurse, as well as,
semiannually by Faculty, and residents
f.
Milestone Assessments
g. Semiannual Assessment by Fellowship Director and Competency Committee
h. Oral Exam August 3rd for UROGYN March 2nd for Urology
15. Fellows Self Evaluations, Assessments and goal setting
48
XIV. Healthstream Requirements:
Hospital requires all Physician trainees to participate in scheduled lectures and/or webinar type
programs on the following topics and others which are added each year. Fellows’ participation in this
program is required.
IMPACT
Annual Corporate Compliance UAB Medicine
Hazard Communication
Confidentiality Form UABHS
GME Lecture#1: (various topics)
GME Lecture#2: (various topics)
GME Lecture#3: (various topics)
GME Lecture #4: (various topics)
GME TB TEST NOTICE
Hand Hygiene Pledge
Patient Safety Clinical Competency
Rapid Regs – Clinical I (UAB Medicine): Compliance, Ethics, Sexual
Har, Workplace Har, Pt Rights, Informed Consent, Adv. Directives,
Grievances, Dev Appro Care, Pop Specific Care, Cult. Competence,
Restraints, Patient Abuse/Assault/Neglect
Rapid Regs - Clinical II (UAB Medicine): Gen/Fire/Elec/Back/Rad./MRI
Safety, Ergo, Lift/Transp, Slips/Trips/Falls, LatexAllergy, HazComm,
WorkplaceViol.,EmergPrep, Infec.Control:HAI, HandHyg, Bloodborne,
StdPrec, PPE
Rules of Behavior-Information Systems (UABHS)
UAB Residents as Teachers Program: Teaching Procedures to Medical
Students
UAB Residents as Teachers: Teaching Medical Students in the
Operating Room
49
XV. Policies and Procedures for Duty Hours and Work Environment
Duty hours are defined as all clinical and academic activities related to the fellowship program; i.e., patient care
(both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient
care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours
do not include reading and preparation time spent away from the duty site.
Purpose:
In compliance with the ACGME Institutional and Common Program Requirements, it is the goal of the Hospital as
the Sponsoring Institution to provide residents/fellows with a sound academic and clinical education. This
requires the Sponsoring Institution to provide “formal written policies and procedures governing resident/fellow
duty hours. (IR.II.D.4.i).
Scope:
UAB has developed the following Duty Hour Policies applicable to every resident/fellow in all GME training
programs:
Definitions (from ACGME Glossary):
1. At-Home Call: Same as pager call or call taken from outside the assigned site. Time in the hospital, exclusive of
travel time, counts against the 80 hour per week limit but does not restart the clock for time off between
scheduled in-house duty periods. At-Home Call may not be scheduled on the resident/fellow’s one free day per
week (averaged over four weeks).
2. Continuous time on duty: The period that a resident/fellow or fellow is in the hospital (or other clinical care
setting) continuously, counting the resident/fellow’s (or fellow’s) regular scheduled day, time on call, and the
hours a resident/fellow (or fellow) remains on duty after the end of the on-call period to transfer the care of
patients and for didactic activities.
3. Duty-Hours: Duty hours are defined as all clinical and academic activities related to the program; i.e., patient
care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of
patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours
do not include reading and preparation time spent away from the duty site.
4. External moonlighting: Voluntary, compensated, medically-related work performed outside the institution
where the resident/fellow is in training or at any of its related participating sites.
5. Fatigue management: Recognition by either a resident/fellow or supervisor of a level of resident/fellow fatigue
that may adversely affect patient safety and enactment of a solution to mitigate the fatigue.
6. In-House Call: Duty hours beyond the normal workday when residents/fellows are required to be immediately
available in the assigned institution.
7. Internal Moonlighting: Voluntary, compensated, medically-related work (not related with training
requirements) performed within the institution in which the resident/fellow is in training or at any of its related
participating sites.
8. Night Float: Rotation or educational experience designed to either eliminate in-house call or to assist other
residents/fellows during the night. Residents/fellows assigned to night float are assigned on-site duty during
evening/night shifts and are responsible for admitting or cross-covering patients until morning and do not have
daytime assignments. Rotation must have an educational focus.
50
9. One Day Off: One (1) continuous 24-hour period free from all administrative, clinical and educational activities.
10. Scheduled duty periods: Assigned duty within the institution encompassing hours, which may be within the
normal workday, beyond the normal workday, or a combination of both.
11. Strategic napping: Short sleep periods, taken as a component of fatigue management, which can mitigate the
adverse effects of sleep loss.
Policy:
Each program must ensure that the learning objectives of the program are not compromised by excessive
reliance on residents/fellows to fulfill service obligations. Didactic and clinical education must have priority in the
allotment of residents/fellows' time and energies. Duty hour assignments must recognize that faculty and
residents/fellows collectively have responsibility for the safety and welfare of patients. The ACGME common
program requirements require the following:
Fellow Duty Hours:
1. Maximum Hours of Work per Week: Duty hours must be limited to 80 hours per week, averaged over a fourweek period, inclusive of all in-house call activities and all moonlighting.
a) Mandatory Time Free of Duty: fellows are provided with one day in seven free from all educational
and clinical responsibilities, averaged over a four-week period. At-home call cannot be assigned
on these free days. One day is defined as one continuous 24-hour period free from all clinical,
educational, and administrative duties.
b) Maximum Duty Period Length:
(2) Duty periods of fellows may be scheduled to a maximum of 24 hours of continuous duty in
the hospital. Fellows are encouraged to use alertness management strategies in the context of
patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and
between the hours of 10:00 p.m. and 8:00 a.m. is strongly suggested
(3) It is essential for patient safety and fellow education that effective transitions in care occur.
Fellow may be allowed to remain on-site in order to accomplish these tasks; however, this period
of time must be no longer than an additional four hours
(4) Fellows will not be assigned additional clinical responsibilities after 24 hours of continuous inhouse duty
2. Minimum Time Off Between Scheduled Duty Periods: Adequate time for rest and personal activities must be
provided.
(a) Intermediate-level residents/fellows should have 10 hours free of duty, and must have eight hours
between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of inhouse duty.
(b) The program must provide back-up support systems when patient care responsibilities are unusually
difficult or prolonged, or if unexpected circumstances create fellow fatigue sufficient to jeopardize
patient care.
3. Maximum Frequency of In-House Night Float: Fellows must not be scheduled for more than six consecutive
nights of night float.
4. Maximum Frequency of In-House On-Call Frequency: In-house call is defined as those duty hours beyond the
normal work day when the fellows are required to be immediately available in the assigned institution. The
following policies apply to fellows in all programs:
a) Fellows are scheduled for in-house call no more frequently than every third night, averaged over a
four-week period.
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5. At-Home Call: At-home call (pager call) is defined as call taken from outside the assigned institution.
a) Time spent in the hospital by residents/fellows on at-home call must count towards the 80-hour
maximum weekly hour limit. The frequency of at-home call is not subject to the every third night
limitation, but must satisfy the requirement for on-day-in-seven free of duty, when averaged over four
weeks. However, at home call must not be so frequent as to preclude rest or reasonable personal time
for each resident/fellow.
b) Fellows taking at-home call must be provided with one day in seven completely free from all
educational and clinical responsibilities, averaged over a four-week period.
c) Fellows are permitted to return to the hospital while on at-home call to care for new or established
patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will
not initiate a new “off-duty” period.
d) The program director and the faculty will monitor the demands of at-home call in their programs and
make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
6. Exceptions to Maximum 24 Hours of Continuous Duty in the Hospital:
a) In unusual circumstances, fellows, on their own initiative, may remain beyond their scheduled period
of duty to continue to provide care to a single patient. Justifications for such extensions of duty are
limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the
events transpiring, or humanistic attention to the needs of a patient or family.
Under those circumstances, the fellow must:
i. appropriately hand over the care of all other patients to the team responsible for their
continuing care; and,
ii. document the reasons for remaining to care for the patient in question and submit that
documentation in every circumstance to the program director.
b) The program director will review each submission of additional service, and track both individual
fellow and program-wide episodes of additional duty.
7. Exceptions to Minimum Time Off Between Scheduled Duty Periods:
a) Fellows in the final year of education [as defined by the Review Committee] must be prepared to enter
the unsupervised practice of medicine and care for patients over irregular or extended periods.
b) This preparation must occur within the context of the 80- hour, maximum duty period length, and one
day-off-in seven standards. While it is desirable that residents/fellows in their final years of education
have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined
by the Review Committee] when these residents/fellows must stay on duty to care for their
The Program Director will review the duty hours of all fellows by sampling throughout the year during
representative months
1. Residents/fellows may report violations of the 80-hour rule through procedures established by calling the
Designated Institutional Official, UAB Hospital; Director, Graduate Medical Education Department; the Corporate
Compliance Hotline at 934-4446, or the Residents/fellows’ Hotline at 934-5025. Such calls will be investigated
and reported to the DIO and Dean's Council for Graduate Medical Education.
2. The Dean's Council for Graduate Medical Education will evaluate each program's compliance and request that
the Program Director describe, develop and implement a plan for corrective action for any rotations exceeding
the 80 hour rule, or otherwise identified as problematic.
Fellows are required to keep and maintain work hour logs on daily basis through the MedHub system. These are
reviewed each week and monitored for any potential work hour concerns, including but not limited to clinical
work approaching or in danger of exceeding more than 24 continuous hours of work or less than 8 contiguous
hours off between clinical duty periods. If there is an obvious violation or if the coordinator has any question or
concern, the Program Director will be contacted. Fellows should review, in detail, Section VI.C. of the ACGME
Common Requirements that clearly outlines duty hour restrictions on a regular basis. Fellows are encouraged to
directly address any concerns regarding potential work hour violations with both the Fellowship Director. The
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Division Call schedule takes into account clinical and on-call hours and is reviewed with the Fellowship Director
on a monthly basis to prevent work hour scheduling that is incongruent with duty hour guidelines.
All violations that are detected through the above system of checks and balances are addressed individually and
analyzed for cause and resolution within the fellowship. Violations are reviewed semiannually with each fellow
and the Fellowship Director. Annual ACGME fellowship program review questionnaires are also reviewed as it
relates to duty hours.
Work Environment
The work environment for the fellowship is designed so that all fellows have individual workspace within a
singular office within the Division academic office. Private call rooms with bedding, lavatory, and shower facilities
are provided and available to all fellows through coded-access 24 hours per day. If at any time, fellow is fatigued
to the point where he/she (or those working with him or her) feels that it would be unsafe for the fellow to
drive home, a taxi can be arranged free of charge through the GME office. All fellows are required to view the
Dean’s Counsel P.P. lecture on fatigue recognition and management. All ACGME requirements (section VI.C.3.)
and UAB GME requirements are applicable for this Fellowship and any breech of these should be reported.
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XVI. Moonlighting Policy
FPMRS Moonlighting Request Form
To: Ed Varner, MD
Fellowship Director
Fellow Name: _____________________________
Date: ______________________
I wish to request to moonlight beginning _________________. The estimated average number of hours per month that I will be
moonlighting is ___________, I plan to moonlight at the following location(s).
1. ______________________________________________________________________
2. ______________________________________________________________________
I attest by initialing that I am in and will continue in full compliance with all program requirements listed below.
1. Moonlighting must not interfere with the ability of the fellow to achieve the goals and objectives of the educational program.
_____ (initial)
2. Fellows participating in moonlighting activities must be fully licensed to practice medicine in the State of Alabama.
_____ (initial)
3. Fellows must use their individual DEA numbers for moonlighting activities. The UAB institutional number cannot be used for
moonlighting activities. _____ (initial)
4. Professional liability insurance coverage for moonlighting activities is not provided by UAB. It is the responsibility of the
institution hiring the fellow to moonlight to determine whether appropriate licensure is in place, whether adequate
liability coverage is provided, and whether the fellow has the appropriate training and skills to carry out assigned duties.
_____ (initial)
5. Moonlight hours will be recorded each week in the fellow’s MedHub duty hours log, and counted with other work hours
toward the 80 hour maximum weekly work hour limit. They will be monitored by the Program Director and Coordinator.
_____ (initial)
I acknowledge that moonlighting likely will not enhance my training, and that it is a privilege not a right. My moonlighting
activities should in no way interfere with my fellowship training. If I do not comply with any of the above rules, in any way
falsify hours or other compliance information, or if moonlighting is felt to adversely affect my performance as a fellow, I
understand that the fellowship Competency Committee may choose to revoke my moonlighting privileges. _____ (initial)
I also understand that the hours spent moonlighting are considered part of my fellowship duty hours and are logged and
monitored as such in the MedHub system, and therefore must be in compliance with all UAB GME Policies and
Procedures. _____ (initial)
I am aware that the UAB malpractice insurance, DEA registration and my Alabama License do not cover me while moonlighting.
_____ (initial)
___________________________________
Fellow’s Signature & Date
___________________________________
PD Signature & Date
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The above request form may be obtained from the program coordinator.
1. Applications to moonlight will be reviewed and approved by the DIO.
2. Audits of moonlighting duty hours logged will be performed by the GME office and trainee’s Program Director. The
moonlighting policy needs to be reviewed every year at the time of the Annual Program Evaluation. A copy of the
moonlighting policy will be available to the GME office as an attachment to the Annual Program Evaluation
document.
3. Applications are valid for a twelve month period or the end of the academic period whichever comes first; at such
time a re-application may be submitted for consideration.
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XVII. Vacations, Sick, and Maternity Leave
In conjunction with the Graduate Medical Education Policy on Paid Leave Benefits (www.umm.edu/gme/doc/GMS-NPaid_Leave_Benefits.doc), the fellowship program has established the following vacation/leave policies.
All leave requests must be submitted through the MedHub system. Once the request for vacation/time off is
submitted it will be reviewed and approved in MebHub. If there is a conflict or concern regarding the request,
it will be discussed with the fellow individually. Vacation and time off should be planned 6 months in advance.
ALL requests should be submitted by the end of July and the beginning of January. Fellows should work out
coverage for his or her clinical responsibilities before such a request is made. Request should also be submitted
whenever the fellow will be unavailable for clinical duties, including (but not limited to) vacation, interviews,
medical appointments, scientific presentations, etc.
Vacation
 FPMRS Fellows are allowed 15 calendar days of vacation each year per the contract with the medical center.
 When call schedules are being developed, attempts will be made to include the weekends before and after
the vacation week. This is not guaranteed.
 Certain times of the year are more challenging for education, patient care, and scheduling. Therefore,
vacation/special requests should not be requested during July and preferably not during the core rotations
(Urogyn and Urology) during the first 3 months of fellowship.
 In general, vacations should be scheduled for one week at a time. Two-week vacations may possibly be
permitted if the weeks ‘straddle’ two rotations. Vacations cannot be scheduled for two weeks during one
rotation unless it is a research rotation and in the case request should be made approximately 1 year in
advance.
 A holiday work schedule will be developed for the Christmas (12/24, 25 ) and New Year (12 31, 1/1) holidays,
Thanksgiving Day , July 4th,MLK Day and Labor Day at a meeting in July- chaired by the Senior Fellow.
 Vacations are explicitly discouraged during the first week of any rotation.
 Conflicting dates will be awarded based on date of request and seniority.
 Vacations taken without an approved request will be taken without pay and may result in disciplinary action
and may be considered as absence from duty days (see last paragraph).
Unused vacation time
 Vacation time exists to be used and not “banked”, but rarely all allotted vacation time cannot be used during
a given year. In that event, the resident may submit a written vacation carry over request for approval by the
program director. Vacation carry over may not exceed half of the annual allotment, and must be used up by
March 1
 There is no reimbursement for unused vacation time.
Job interviews
 Up to five week days off.
 Efforts should be made to schedule job interviews on days that minimize disruption of clinical responsibilities
and patient care.
 Potential employers understand the importance of clinical responsibilities and patient care; it is perfectly
acceptable to negotiate an interview date. You are expected to coordinate with the other fellows.
 More than five days away from the fellowship for interviews and other career development must be taken
from the allotted vacation time or taken without pay. The appropriate vacation request form must be
completed.
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Sick/medical leave
 If a fellow is sick and cannot come to work, Fellow must call the senior fellow or, if the illness develops during
the 8 to 5 hours on week days the program coordinator, Julie Burge at 934-2569. These calls should be made
as early as possible.
 Extended medical leave will be handled on a case-by-case basis in accordance with medical center policies.
The Fellowship Coordinator will help you process the necessary paperwork.
Emergency leave
 In the event of an absence resulting from sudden illness or death in the immediate family, the fellow will
complete the Leave Request form on the day s/he returns to work.
 Notification policies as listed in Sick/medical leave section (see above) also apply.
Bereavement Leave
 In the event of the death of a spouse, first degree relative, or member of the resident’s household, time off is
granted without loss of pay for three working days. Additional time off without pay may be requested.
Family Medical Leave Act (FMLA)
 FMLA is available for specified family and medical reasons. This includes but is not limited to maternity
leave, paternity leave, and extended medical leave. The program will grant unpaid family leave (childbirth,
adoption, serious health condition of a spouse, parent or child) in compliance with all state and federal laws.
Paid leave after childbirth shall be four weeks, using 3 weeks of your annual sick leave and one week of your
annual vacation. A fellow can take up to 6 weeks of leave with pay using all sick and vacation time, assuming
that no leave has been taken during that current academic year and with prior approval from the Fellowship
Director.
 For specifics on this policy, refer to the FMLA Fact Sheet found on the hospital intranet at
http://intra.umm.edu/ummc/employee/benefits/documents/FMLAFactSheet.doc The Fellowship
Coordinator will help you process the necessary paperwork.
Military Obligation
 Leave will be granted for military or reserve obligations. Military obligations must be scheduled well in
advance of the dates of the obligations.
Jury Duty
 Paid leave will be granted for jury duty. However, jury duty is considered an absence from the educational
program in the eyes of the ABOG and may have to be made up. The program director will therefore be
happy to furnish a letter requesting that the fellow be excused from jury duty; however this request is not
always granted by the court.
Conferences
 Whenever possible, the department will support a resident attending a conference to present first-author
research. These requests must be submitted at least three months prior to the planned conference. Time
away beyond that necessary for presentation of the research may not be able to be granted (i.e., attendance
for the full length of the meeting may not be possible, however effort will be made to provide it and can
generally be worked out).
 Each urogyn fellow receives $416.66 a month, (prior to taxes), ($5000 Total) in his/her pay check for
reimbursement. For further approval of travel reimbursements, an accounting of your personal expenditures
should be submitted following each trip. Once this has been met, the division may reimburse monies above
and beyond the $5,000 only with Dr. Richter's approval. It is taxed income and will be accounted for in
approving future expenditures. Your personal expenditures are business related expenditures such as books,
journals, meals, travel to meetings, etc.
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Overall Absence from the Program:
Please note that ABOG’s requirements of Fellowship Programs include the following:
 The Residency Review Committee in Obstetrics and Gynecology (RRC) under the direction of the
Accreditation Council for Graduate Medical Education (ACGME) requires that absences of more than eight
weeks in any of the first three years of training, more than six weeks in the senior resident year, or
absences totaling more than 20 weeks require an extension of the training period by the amount of time in
excess of the above listed limits. The additional training must be completed by September 1 to receive
permission to take the written examination of The American Board of Obstetrics and Gynecology (ABOG) in
June of the following year. Absences include vacations, sick leave, jury duty, and maternity or paternity
leave. Attendance at scientific meetings or postgraduate courses approved by the Program Director is not
considered an absence in this context.
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XVIII. Case List
Each fellow will be added to the ACGME case log site specific to our program at the beginning of the fellowship.
Fellows are responsible for logging all of their cases into the system. This will be monitored on a regular basis by the
Program Coordinator and Director and, formally, at the time of each semiannual competency meeting with the
Program Director (and Competency Committee if deemed unacceptable).
Case Logs for Boards
1. A Case Log form must also be completed as part of the Board Exam application process. The form must be
completed and submitted on line.
2. The deadline for submission of all application materials, including the case log will be set by the boards and may be
found under the FPMRS subsection of ABOG.org or ABU.org.
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XIX. Fellow Evaluations for Feedback and Advancement
Semi Annual Fellow Evaluation: Each fellow will meet formally with the fellowship director and if indicated other
members of the competency committee semi-annually in early January and May of each year. That meeting will
include the following listed below.
 A review of all competency evaluations of the fellow by faculty, residents, nurses, other medical staff,
medical students, and patients.

A review of Rotation Evaluations and Focused Assessments

Review of Milestone Conference Evaluations

A review of the fellow’s academic portfolio which include a record of his/her self-learning, UAB
presentations, National Presentations, duty hours, case logs, and his/her Curriculum Vitae.(Section VIII)

A review of the fellow’s progress in research which will include the thesis project as well as other
projects. Adherence to time tables established will be expected. Other professional achievements will be
reviewed as well.

Self-Assessment review will include a review of the fellow’s present and previous self-assessments, goals
and how well the goals have been met. One to three new goals will be determined for the upcoming six
months. The fellow will then be given his/her overall assessment by the program director and if there are
any inadequacies, these will be reviewed by the competency committee, with consultation from others if
need be, to determine if further action will be required.
Evaluative Tools (See MedHub)
 Rotation Evaluations: upon completion of Urogynecology, Urology, Geriatric, Research, or Colorectal
rotations the faculty for that rotation will complete the specific rotation evaluation form, which will be
submitted electronically to the fellowship coordinator. The individual faculty members may also give the
fellow his/her perception of the fellow’s progress. If upon review of the evaluation by the coordinator
there is a reason for immediate review by the fellowship director and competency committee that will be
instituted with immediate action taken with the fellow when felt indicated. It is expected that
educational and competency goals will be met as outlined and on each evaluation sheet. The faculty
assessment of the fellows’ knowledge during each rotation should be obtained by informal questioning
of the fellow or by observation of a fellow who is performing teaching activities. The faculty member and
fellow will adjust the evaluations based on the time lines given for each learning assignment. Additionally
the faculty may prefer to perform an informal oral examination of the fellow. These rotation evaluations
are also reviewed with the fellow by the Fellowship Director at the semiannual evaluations.

Focused Assessments of Specific Clinical Activities include clinical evaluations, (POP-Q, Urodynamics,
and Anal/Rectal Studies), as well as, evaluations of specific surgical procedures listed. These will be
performed by designated faculty members (or nurse practitioner for POPQ and urodynamic evaluations).
It will be the responsibility of the fellow to notify the program coordinator when these assessments need
to be sent through the MedHub system. The evaluation for Robotic Surgery will be submitted a similar
manner.

Milestone Conference Evaluations: Interactive conferences based on the Medical Knowledge and
Patient Care Milestones will be directed by faculty members for the fellows together. Various
questions will be given to each fellow at the three levels to better assess performance on these
competences. There Communication skills will also be assessed. There will be a conference on each of
the topics each year and evaluations of each fellow will be performed and discussed with her/him.
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
Presentation Assessments: These will be completed by faculty, residents and other fellows following
observed presentations (conferences, national meetings, or other) and handed to the fellowship director
or faxed to the fellowship Coordinator, Julie Burge as soon as possible following the presentation. These
will be used to further assess all of the clinical competencies and for instruction of fellows on teaching
techniques.

Fellowship Global Competency Evaluations: Faculty and residents will submit these electronically every
six months. Other health care workers, divisional nursing staff, medical students, and patients will submit
their evaluations periodically as directed by the clinic or operating room nurses. All will be reviewed at
least semiannually and Competency Goals will be created with the Program Director.

Formal Oral Exam: This will be given toward the end third year to Urogynecology fellows and the end of
the second year to urology fellows. The exam will be developed and administrated by the Competency
Committee. If a fellow’s performance is unsatisfactory, he/she will be personally counseled with the
need for specified learning activities prior to completion of his/her fellowship.
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XX. Responsibilities of the Fellowship Faculty










To know educational and clinical (competency based) goals and objectives of the fellowship related to your
individual expertise.
To instruct of the fellow in clinical and surgical patient care, related to these objectives and evaluate their
progress during all activities.
To perform Rotation evaluations after each rotation for the fellow on that rotation.
To participate in selected Milestone Conferences as well as other conferences in order to instruct and
evaluate fellows and for self review of sujects
To perform a Global Competency Evaluation semi-annually on each fellow who rotated on your service.
To provide both positive and negative feedback to the fellows as necessary.
To perform focused assessments on specified surgical procedures performed by the fellow
To perform assessments of oral presentations or teachings sessions performed or conducted by the fellow
Periodically, on a rotational basis, participate in the development of and administration of an oral exam to
one or two fellows
To perform or participate in “Scholarly Activity” to advance yourself as an academician and teacher
XIX. Responsibilities of the Fellow in Female Pelvic Medicine and
Reconstructive Surgery are:
To adhere to all policies and meet all requirements outlined in the above sections and, in doing so, well
demonstrate the six clinical competencies which include the following:
1. Medical Knowledge – By demonstrating thorough evidence based understanding of the FPMRS
Specialty topics.
2. Professionalism – To demonstrate professionalism in patient care, in relationships with other health
care workers, and in recordkeeping and fulfillment of all the requirements of the fellowship.
3. Patient Care – To demonstrate application of medical knowledge in the evaluation and management
of patients in this subspecialty. This will include the development of all the other competencies.
4. Interpersonal and Communication Skills – There should be demonstrated during interactions not
only with patients but with all others who the fellow is associated.
5. Problem-Based Learning and Improvement – The fellow will demonstrate the ability to recognize
shortcomings of various aspects of his/her practice, learn how to define a problem, develop an
evaluation of how the problem may be solved and progress in to resolution of the problems by
various means including designed comparison studies.
6. System-Based Practice – Fellow will be expected to coordinate all aspects of patient care and, in
doing so; will communicate with others in the system as a whole to facilitate the optimal
management of an individual patient and of his/her practice as a whole.
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