Gynecology Oncology Fellowship
(apply here)
Introduction
Dr. Peter Rose, Fellowship Director
The Gynecology Oncology fellowship at Cleveland Clinic is a three-year program that accepts it’s trainees following completion of residency from an American Board of Obstetrics and Gynecology approved program.
The primary goal of the fellowship is to provide an in-depth experience in clinical and investigative work to allow pursuit of an academic career within gynecologic oncology. Fellows obtain experience in the basic science laboratory as well as the clinical aspects of gynecologic oncology. The fellows have an intensive and ongoing laboratory experience allowing them to develop quality collaborative research programs during their future careers. The fellows also have an intensive and broad based clinical experience with progressive responsibility resulting in the capability of providing independent subspecialty care within a tertiary medical center.
The major strength of this program is the strong clinical experience gained at our institution as well as our collaborating institution, both renowned for combining patient care, research and education. Currently the fellow’s initial year consists of laboratory experience in the Departments of Cancer Biology or Cancer Pharmacology. The fellows have a one-year experience under the direction of one of the senior investigators. This experience will be without interruptions related to clinical duties and during this year, the fellows complete required graduate course work in biostatistics and molecular biology. The laboratory experience will allow an intensive study into the scientific basis for current and future cancer care. It is anticipated that the fellows will supplement the initial laboratory research experience with additional ongoing projects as well as by clinical research projects during the latter two years of the fellowship.
Outcomes
“Our obstetric and gynecology services were ranked number eight in the country and number one in Ohio in the 2008 U.S. News & World Report physician survey. Our patients benefit from innovative, leading-edge care arising from extensive research and vast clinical experience. Our collaborative approach, fostered in interdisciplinary care centers, consistently improves clinical outcomes, increases patient satisfaction and stimulates research. Our Centers of Excellence include maternal-fetal medicine, menstrual and fibroid treatment, female pelvic medicine, reproductive/infertility and gynecologic oncology.” Tommaso Falcone, MD, Vice Chair, Office of Professional Staff Affairs, Professor and Chairman, Cleveland Clinic Obstetrics, Gynecology and Women’s Health Institute.
Quality counts when referring patients to hospitals and physicians. Designed for a healthcare provider audience, the Outcomes books contain a summary of our surgical and medical trends and approaches, data on patient volume and outcomes, and a review of new technologies and innovations. Review the outcomes for Gynecology Oncology.
Resources
The Gynecologic Oncology fellows benefit from a strong clinical program marked by high quality and complex patient care provided in a setting noted for collaboration and collegiality. The hallmark of the Cleveland Clinic has been the excellence of its patient care that has largely developed as a result of the collegial relationship among departments and individual clinicians. The large volume of patient material provided enables the fellows to have a broad based exposure to clinical gynecologic oncology marked by progressive responsibility in both the outpatient clinic and the hospital. The fellows currently work with four gynecologic oncologists at the Cleveland Clinic and four at our collaborating institution, the Case School of Medicine/University Hospital (CWRU/UH).
The gynecologic chemotherapy service is a fully integrated portion of the Gynecologic Oncology program both at Cleveland Clinic and CWRU/UH. In addition to the gynecologic oncologists, it is staffed by expert gynecologic nurse clinicians. When possible, patients are treated on National Cooperative Group clinical trials as well as in house studies. Major decisions resulting in surgery, radiation therapy or a change in chemotherapy regimens are frequently integrated into the outpatient clinics when the fellows are participating.
In addition to an intensive exposure to conventional procedures for gynecologic malignancies, the fellows have an opportunity to participate in the development and application of endoscopic approaches to gynecologic cancers. The Minimally Invasive Surgery Center at this institution has attracted world-class individuals including Dr. Tommaso Falcone (Chairman of Obstetrics and Gynecology). The Minimally Invasive Surgery Center allows the fellows to participate in surgical innovation, research, and new technology related to gynecologic oncology.
A series of strong and stimulating off-service rotations have been arranged. These experiences will offer the fellows an intensive exposure to allied disciplines with the opportunity to work with experienced clinicians on very active services.
- 8 months Gynecology Oncology Cleveland Clinic
- 8 months Gynecology Oncology CWRU/UH
- 4 months Gynecology Oncology
Hillcrest/Fairview Hospitals
- 1 month Radiation Oncology
- 1 month Surgical Intensive Care Unit
- 1 month Palliative Medicine
- 1 month Breast
The total number of operations performed by three clinical fellows in 2007-2008 was 961. Of those, 773 were major procedures and 188 were minor.
Educational Program
The fellow will have the opportunity to enhance their individual teaching skills. There will be at all times residents from the integrated Cleveland Clinic/MetroHealth Medical Center Residency Program. A second and fourth year resident is assigned full time to the oncology service. We also have the “Gruber Fellowship” which allows visiting 3rd year Ob/Gyn residents to have a more intensive experience on our service, often leading towards application for fellowship training. Medical student participation on the Gynecologic Oncology Service consists of third year clerks from CWRU/UH, and fourth year elective students from other institutions. The fellows also have many other educational opportunities for the teaching of allied medical personnel and nursing staff.
The primary responsibility of the house staff and student under the direction of the Gynecologic Oncology fellow is the direct care of all hospitalized patients. Morning work rounds are supervised and organized by the fellow. Afternoon/postoperative rounds are likewise organized by the fellow and directly supervised by the Gynecologic Oncology faculty.
During the first few months of the academic year, the faculty supervision is more intense towards the day-to-day running of the clinical service. When possible a more senior fellow also assures that a smooth transition occurs. This ensures the proper orientation and progress of the junior fellow. Additionally an effort is made to especially involve the junior fellow in the outpatient setting so that they may participate in screening clinics, the evaluation of new patient referrals, as well as in the chemotherapy clinics. The senior fellow will always have responsibility primarily for hospital and operating room coverage. Depending on the rotation these responsibilities are quite fluid, but adherence to the concept of progressive responsibility and complexity is our goal.
All members of the team will participate in the outpatient clinics as time allows. A “new patient clinic” is conducted on Tuesday mornings. At this time as many new patients as possible are scheduled and divided among the team members by the fellow. Initial examination is performed by the fellow and then subsequently supervised by the individual faculty member who has received the referral. An effort is made to involve the fellows in new patient assessment whenever they are available. Management decisions and plans are then collectively reviewed and implemented. Other outpatient activities will be as time allows given the fellow’s responsibilities in the hospital/operating room. However, the fellows are aware that we expect outpatient clinic participation when possible as we believe it is critical to their training.
The primary night call responsibility at the Cleveland Clinic and University Hospitals is the in-house
resident. The Gynecologic Oncology fellow will be available for resident backup as well as calls concerning Gynecologic Oncology patients within the system. The Gynecologic Oncology fellows will continue to rotate call seven days per week from home when the days work has been completed. The resident is expected to review all major management decisions with the fellow. One of the Gynecologic Oncology faculty will also be available at all times for fellow consultation and problem management. The fellow, resident, and gynecologic oncologist on call, conducts weekend rounds.
Gynecology Oncology Fellowship Graduates 1996-present
The fellow in surgery is directly supervised and advised by the faculty at all times. The goal of the fellowship is progressive surgical responsibility so that the fellow may become the primary surgeon, performing all radical surgeries, by the completion of their fellowship. The Gynecologic Oncology faculty is in attendance in the operating room during the critical portions of all procedures. Fellows are not placed into positions unwarranted by their surgical experience and expertise. The fellow will be operating with the faculty on all radical cases. They will progress from initially being first assistant to the operating surgeon as their skills and experience permit. During non-radical or benign cases, the fellow may be the primary surgeon assisted by the gynecology resident. At that time, the faculty member will be acting as a second assistant and consultant. This same scheme also applies to outpatient surgeries. The Gynecologic Oncology team performs the majority of gastrointestinal and urologic procedures performed on our patients. When other consultants are required to ensure optimal patient care, the Gynecologic Oncology fellows will continue their surgical participation at the discretion and direction the consultant. The fellow and radiation therapy resident assigned to gynecology will share performing brachytherapy cases when our fellow is available under the supervision of the attending radiotherapist.
The Gynecology Oncology fellows will participate in weekly Departmental Grand Rounds. Included in these conferences are monthly Quality Assurance and Improvement meetings. The oncology fellows actively participate in these conferences and present all pertinent patient materials related to oncology patients. Additionally, the fellows are required to present the results of their research on an annual basis at Departmental Ground Rounds.
The fellow will participate in weekly Gynecologic Oncology Pathology Conferences. During these conferences, one of the gynecologic pathologists reviews the histopathologic materials of all recent patients. Additionally, the fellow will lead the weekly Gynecologic Oncology Patient Management Conference during which all hospital patients and their planned therapies are reviewed with the faculty and other personnel. Recognizing the strength we have in gynecologic pathology (currently five Gyn Pathologists) and the Pathology Department’s sub-specialty sign-out of surgical specimens, we place a strong emphasis on pathology review and its integration into clinical management. The fellows as well as other trainees are responsible for the presentation of new patients at the weekly conferences and proposed programs of management will be presented and defended.
The didactic course for the fellows is a blend of methods to include fellow presentations, cases discussions, and didactic lectures. The course materials are assembled into a useful resource for boards, with the current plan being a collection of CDs.
The Gynecologic Oncology fellows are encouraged, as time permits, to attend the relevant seminars at the Lerner Research Institute as well as the Medical Oncology Seminar Series. These programs are offered throughout the academic year. The initial three months of medical oncology seminars are intended as an overview of oncology for new medical oncology fellows and first year Gynecologic Oncology fellow(s) will be encouraged to attend. Approximately six times per year a combined Cleveland Clinic/CWRU Journal Club occurs. Each fellow presents and reviews an article of current interest with the focus on a specific topic.
The fellows actively participate in the Annual Research Day of the Cleveland Society of Ob/Gyn, as well as Cleveland Clinic Research Day. At the latter, the fellow will be expected to present their current research in the form of poster presentations.
The first year fellow will complete two post-graduate courses. Examples are: at Case Western Reserve University during the fall semester - Biology 460-Introduction to Molecular Biology and Genetics and Epidemiology or Introduction to Clinical Research and Biostatistics 431-Statistical Methods or Statistical Science in Medical Research. Comparable exchanges may be made with the approval of the fellowship Program Director.
The first year of fellowship consists of a protected 12-month laboratory experience. During this time, the fellows are without weekday clinical responsibilities, but may be required to cover night or weekend call during the year. Laboratory projects will be carried out in the Department of Cancer Biology within the Research Division or Cancer Pharmacology in the Taussig Cancer Center. There is a wide range of research opportunities available including focusing on molecular genetic analysis of common human malignancies, studying ovarian cancer growth factors and tumor markers (in particular the area of bioactive lysophospholipids), work on interferons, tumor suppression, innate immunity, antisense and apoptosis, molecular mechanisms of initiation and progression of carcinogenesis, and studying molecular mechanisms controlling cellular responses to extra cellular stimuli. In addition, the laboratory of Dr. Ram Ganapathi in the Taussig Cancer Center focuses on experimental therapeutics and the mechanisms of tumor resistance. Skills of bench research, design, and execution will be emphasized. While it is anticipated that the fellow will complete their primary project during their first year of fellowship, opportunities for continued interfacing with the research division fellows and laboratory personnel is encouraged to allow additional experience and maturation of projects. Opportunities for non-laboratory, prospective clinical research projects will also be considered individually for those fellows desiring more clinical or epidemiological research experiences.
The fellows are expected to assume progressive responsibility and independence during the fellowship with the eventual goal of functioning independently in the practice of gynecologic oncology. The initial experience will be closely monitored and supervised until clinical expertise and acumen have been demonstrated. At this point progressive responsibility, both in the peri-operative as well as intra-operative care of patients, will be given to the fellow. This includes more independent functioning within surgery; however, Gynecologic Oncology faculty will continue to be present within the operating room and to be scrubbed during the critical portions of all procedures. As noted previously in regards to surgical responsibility, the fellows will progressively assume the responsibilities of primary surgeon or in the case of non-radical/benign surgery will be the first assistant to instruct the resident. This progression will occur over a two-year period and will be paced to meet the abilities and experience of each individual fellow. In addition to clinical responsibility, it is expected that trainees will also progress in their abilities to conduct independent research, teaching of residents and medical students as well as administrative duties. The program director and other faculty will be regularly meeting with the fellows to assess their progress in these goals so that individual weaknesses can be identified, remedied and increased responsibility assumed.
Evaluations
The Gynecologic Oncology Program will be using the standard electronic evaluation form provided by our institution on a biannual basis, thereby providing an opportunity for the program director to meet with the fellows and to monitor their progress. Any significant deficiencies will be addressed. Ultimately, the successful completion of the written and oral oncology boards will be used to monitor the overall success of this program.
Gruber Visiting Fellowship
(apply here)
Through the generous support of Mr. and Mrs. Tom Gruber, visiting rotations of one month are offered to individuals considering a career in Gynecologic Oncology or wishing to expand their clinical experience. Selected residents, from American Board of Obstetrics and Gynecology (ABOG) approved residencies, will work with the Gynecologic Oncology team to care for patients with complex and diverse gynecologic cancers. Participation will involve hospital/OR responsibilities and outpatient and chemotherapy clinic participation. Regular conference and didactic presentations are offered.
Participants can expect enhanced surgical experience and an improved understanding and exposure to the discipline of Gynecologic Oncology.
Residents in ABOG approved programs entering their PGY3 year are invited to apply. Visiting residents will have access to all facilities and support in the Cleveland Clinic Division of Education. Round-trip transportation expenses, a furnished apartment close to the Cleveland Clinic and a monthly stipend will be provided. Malpractice insurance must be provided by the home institution.
The application deadline is May 1 of the preceding academic year.
How to apply:
Gynecology Oncology Fellowship
Physician who are eligible to apply will be completing a four-year residency program in obstetrics and gynecology accredited by the Accreditation Council for Graduate Medical Education in the United States or a five-year residency program in Canada accredited by the Royal College of Physicians and Surgeons of Canada.
Applicants also must be eligible to take the American Board of Obstetrics and Gynecology (ABOG) written examination.
All faculty members review each application. Based on their credentials and letters of reference, select applicants will be invited to Cleveland for a formal interview. This full-day interview includes meetings with the entire staff, a tour of the Cleveland Clinic and an opportunity to meet with current fellows. The final selection is made at a joint meeting of all staff members. The National Resident Matching Program administers the selection process. Salary and benefits are competitive. Applications are submitted via the ERAS website and must be completed by April 15 of each year for the position beginning July 1 of the following year.
Gruber Visiting Fellowship
Physician who are eligible to apply will be completing a four-year residency program in obstetrics and gynecology accredited by the Accreditation Council for Graduate Medical Education in the United States or a five-year residency program in Canada accredited by the Royal College of Physicians and Surgeons of Canada.
Applicants also must be eligible to take the American Board of Obstetrics and Gynecology (ABOG) written examination.
Submit application along with all required documents to Pat Wolf, Education Manager.
CONTACT INFORMATION: To request more information, contact:
Pat Wolf, Education Manager
Department of OB/GYN, A81
The Cleveland Clinic
9500 Euclid Avenue
Cleveland, OH 44195
Phone: 216-444-4884
Fax: 216-636-1296
wolfp@ccf.org
