Gynecology Oncology Education Program
Contents:
Morning Work Rounds: Fellows, residents and medical students will evaluate patients, develop plans
and write daily progress notes. The fellow will be expected to provide guidance to the other trainees and
take primary responsibility for ICU patients and other complicated situations. These rounds will be
completed before the 7:00 am “Board Rounds.”
Board Rounds: From 7-7:30 each morning, all of the inpatients will be discussed, including consults.
The faculty on service will attend this report and provide teaching points, supervision and direction.
This also allows the entire team to learn about the complex patients as well as their daily plan.
Formal Teaching Rounds: After clinic is complete each day (5-6 pm), the team reconvenes for
formal teaching rounds. The on-service faculty runs these rounds, along with other available faculty.
Patients are presented in a formal manner and radiological studies reviewed by the entire team.
Bed-side teaching provides an invaluable opportunity to teach physical exam findings and communication with patients. Emphasis will also be placed on presentation skills, development of a logical plan,
and knowledge building in both postoperative care and gyn cancer topics.
Saturday and Sunday Rounds: Faculty weekend morning rounds with fellows, residents and students
will include all of the elements of teaching mentioned above, only in a somewhat less formal environment.
Detailed daily plans will be developed for safe sign-out of each inpatient.
Off-Service Rotations: Specific off-service rotations were chosen based on both the clinical
educational opportunities as well as the quality of the faculty in that specialty. Each of the rotations
has a proven track record of excellence in house staff education. The specifics of the educational
organization will be left to the faculty in charge of the rotation for that specialty. However, the
educational content and value will be reassessed on a regular basis to be certain that they are in line
with the Guide to Learning in Gynecologic Oncology. The quality and amount of educational opportunities
will also be routinely evaluated. Please see section 2h for more specifics on off-service rotations.
Chemotherapy Clinic: Tuesday and Friday morning clinics are dedicated to seeing patients actively
receiving chemotherapy for gyn cancers. The vast majority of patients under active treatment are seen in
one of these two sessions. This multidisciplinary clinic allows for the consolidation of resources to best
serve the needs of our patients. Cancer genetics, cancer psychology, social work, clinical research staff
and nutrition services are assigned to the clinic during this time. Faculty consists of multiple gyn
oncologists as well as a medical oncologist with special interest in gyn cancer, Dr. Howard Bailey. Dr.
Bailey adds to the educational experience of trainees by his ability to put the chemotherapeutic agent in
the context of many different disease sites. His long-standing interest in drug development and Phase I trials
provides the trainees with excellent insight into the details of novel therapeutics.
The fellow will be expected to evaluate the patient, determine treatment benefit and toxicity, and
develop a plan. This will then be presented to the faculty who will also see and examine the patient.
Once a treatment plan is determined, they will write the chemotherapy orders, if appropriate, under direct
supervision of faculty. This clinic provides multiple opportunities to communicate with patients regarding
disease progression, changing or stopping treatment, hospice care and end of life issues.
Faculty Clinic: Individual Faculty clinics occur each weekday and include new, pre and postoperative,
follow-up and urgent patients for that physician in that week. Fellow duties will be similar to that described
above. After obtaining a history and basic physical, they will present the patient to the faculty. Patient
will then be examined by the fellow and faculty in concert, including the pelvic exam, and a plan determined
by the fellow. If this is approved by faculty, the fellow will then complete the orders and documentation.
Operating Room: The Gyn Onc Division has dedicated block time all day Monday, Tuesday, Wednesday and
Friday; as well as 1/2 day Thursday. In addition, UWHC has created an “oncology room” with time available
each day of the week for semi-urgent cancer cases. This provides the service with adequate OR time during
daytime hours of the week for its large case volume. All cases, whether major or minor, complicated or
simple, inpatient or ambulatory will be performed under direct supervision of faculty. In straight-forward
cases (simple hysterectomy, adnexal surgery), the resident will likely perform the surgery with the direct
assistance of either the faculty or the fellow. In more complicated procedures (advanced laparoscopy, radical
surgery, bowel resection, etc) the fellow will perform the surgery with the direct assistance of faculty.
It is the faculty’s responsibility to ensure safety by providing graduated responsibility. The fellow will
be given immediate feedback as well as written evaluation on specifics of surgical technique such as tissue
handling, use of assistants, ease of instrument use, and knowledge of the procedure.
Division of Responsibility: During the times of year when 2 fellows are on service at the same time,
they will alternate as the fellow on service. This fellow will be directly responsible for the inpatient
service for the week. The OR cases will be divided between the fellows commensurate to level of training.
One of the fellows will be in clinic each day, while the other is in the OR. When only one fellow is on
service, outpatient clinic opportunities will occur when less complex cases are occurring in the OR that are
more appropriate for resident education. Chemotherapy clinics and new patient appointments will be priorities
for fellow education.
Meriter Hospital: The vast majority of Fellowship education and responsibilities will take place at UWHC.
Currently, 95% of gynecologic cancer surgeries are performed at UWHC in conjunction with UWCCC. It
is our expectation that there will not be a marked change in this distribution over time. However, we
chose to include Meriter Hospital in this application for the following reasons: 1) The Department of Ob/Gyn
is based on the Meriter campus, including the administrative offices and conferences; 2) The Department is
negotiating with Meriter to have a small surgical and consultative gyn onc presence at their facility—to likely
include routine endometrial cancer patients, low-risk adnexal masses, and generalist support for difficult
benign cases. At this point, we do not plan to assign a fellow to Meriter, and no distinct educational
curriculum will be created unless the volume increases. It is expected that the fellow may join the faculty
for the occasional surgery/consult at Meriter. Educational organization will be the same as if the case had
occurred at UWHC.
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Attending staff are present for the substantive portions of all major and minor surgical procedures.
Fellows will benefit from direct supervision and hands-on training in the operating room. Our expectation is
that fellows be involved in all aspects of patient management. At the heart of gynecologic oncology training
is the development of specialized technical skill and surgical judgment necessary to manage patients with
gynecologic malignancies. Focused instruction and technical training in the operating room is best learned
directly from experienced practitioners. Fellows will always benefit from our constant supervision and will
not be left to learn independently.
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Weekly Didactics
These didactic sessions will occur weekly from 0730-0830 on Wednesday. This time can be changed to
0700-0800 when the Cancer Center Grand Rounds will be covering a topic of interest. The sessions
will be attended by Gynecologic Oncology faculty as well as fellows. These are specifically designed
for gynecologic oncology fellow education. Reading materials will be distributed ahead of time and will be
reviewed at each session. The choice of topics has been developed to ensure adequate review of all portions of
The American Board of Obstetrics and Gynecology Guide to Learning in Gynecologic Oncology. These topics will
be covered over a 2 year period to ensure that each fellow has the opportunity to be involved with each topic
at least once. This will allow approximately 4 days for each topic listed below. When appropriate, faculty
from other disciplines such as Medical Oncology, Surgical Oncology, Radiation Oncology, and Pathology will be
invited to cover certain topics.
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Gynecologic Oncology Tumor Board (Thursday 1030 – 1130/weekly)
Selected cases highlighting difficult pathologic diagnoses as well as controversial treatment
decisions are presented at this weekly conference. Faculty from pathology, medical oncology,
radiation oncology, and gynecologic oncology attend, along with residents, and research coordinators. Cases
are presented by the residents followed by pathology review and in-depth discussion of treatment options.
Gynecologic Oncology Chapter Review (Wednesday 430/weekly)
This review of chapters from Berek and Hacker’s Practical Gynecologic Oncology is designed as a
review for the residents and fellows on the Gynecologic Oncology service. Epidemiology, diagnosis,
staging and treatment of gynecologic cancers will be the focus of this review. All residents,
fellows, and medical students on the service are required to attend. All faculty attending are
responsible for the patient cases and discussion.
Gynecologic Oncology Journal Club (Thursday 1830-2000/monthly)
This conference will be held monthly in one of the faculties’ homes and will include faculty,
fellows, residents on service and any laboratory or research personnel that have an interest.
This conference will highlight 1-2 publications pertinent to gynecologic oncology that have appeared
in the recent literature. The focus of this journal club will be the critical review of the
literature. Time will be spent reviewing study design, statistical methods, and presentation and
interpretation of the data. The faculty will facilitate this discussion.
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Chemotherapy course with medical oncology fellows
This course can be attended alongside medical oncology fellows and will encompass all aspects of
chemotherapy. Lectures covering topics including general principles of chemotherapeutics, mechanism
of action of specific agents, guidelines for clinical evaluation, toxicity, and administration will
be covered. In addition, the role of hematopoietic agents will be covered. This course is taught by
faculty in oncology as well as pharmacology.
Radiation biology with radiation oncology residents
The University of Wisconsin offers a semester-long course on radiation biology and physics which is
taught by faculty in radiation oncology. This course is designed for radiation oncology residents,
as well as medical physics students.
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UW Paul P. Carbone Comprehensive Cancer Center Grand Rounds
This conference held weekly on Wednesday mornings at 0800 is dedicated to topics related to both
clinical and basic/translational research of cancer. It is attended by physicians and researchers
in the cancer center. Faculty and fellows would decide in advance which topics would be of interest
and move our Wednesday morning didactic 30 minutes earlier to allow attendance at both educational
opportunities.
UW Department of OB/GYN Grand Rounds (Thursday 0800/weekly)
This conference is held weekly from September through May and invites a broad range of speakers from
both within and outside the UW to speak on all topics of Obstetrics and Gynecology. Gynecologic
Oncology faculty are responsible for approximately 2-4 topics per year.
UW Department of OB/GYN Morbidity & Mortality (Thursday 0700/3 per month)
This conference is held 3 out of 4 weeks of each month and reviews reportable events from all UW
Ob/Gyn services as well as interesting cases.
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Graduate Level Courses
The fellows will be required to take two courses- one in Biostatistics and one on Cancer Biology.
Fellows with no prior laboratory experience will be advised to take the Molecular techniques course
(Biochem 651) where as those with experience can take the Cancinogenesis and Tumor Cell biology course.
A brief description of the courses is given below.
- Introduction to biostatistics (BMI 541) This course is designed to provide biomedical researchers
the fundamental understanding of biostatistical methods. Topics include: descriptive statistics, hypothesis testing,
estimation, confidence intervals, t-tests, chi-squared tests, analysis of variance, linear regression, correlation,
nonparametric tests, survival analysis and odds ratio. Biomedical applications are discussed for each topic. This is a
3-credit hour course.
- Carcinogenesis and Tumor Cell Biology (Oncology 703) This course provides a basic understanding of the molecular
mechanisms underlying cancer. Special emphasis is given to factors involved in tumor production in humans and experimental animals,
and to the biology and biochemistry of neoplasia.
- Biochemical Methods (Biochem 651) This is an integrated lecture and laboratory course that provides the basic understanding of
molecular techniques commonly used in life sciences research. The fellows will obtain a thorough understanding of the biochemical,
catalytic, molecular biological, and physical techniques. Lectures are primarily scheduled in the early part of the semester, so that
theoretical and practical aspects can be introduced before the corresponding lab experiments are undertaken. The laboratory experiments
are designed to provide "hands-on" experience with the equipment and techniques that are the foundations for modern biochemical and
clinical research. These experiments focus on instrumental techniques such as spectrophotometry, gel electrophoresis, enzyme assays,
scintillation counting, and protein chromatography. Students also participate in an extended lab exercise in which they clone and
overexpress the gene operon responsible for luminescence in the marine bacterium Vibrio fischeri. This comprehensive exercise introduces
new molecular biological methods as well as further refines the techniques introduced earlier in the class.
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Scientific Writing Workshops
This workshop is held twice annually. It offers a two-day Manuscript Writing section and a two-day Grant Writing section.
The course is conducted to meet individual, institutional and national needs to enhance training programs for clinical investigators.
It utilizes lectures, discussions, computer demonstrations and writing exercises to teach knowledge and skills necessary to be successful in
manuscript ant grant writing.
Short Course in Clinical Research
It utilizes lectures, discussions, computer demonstrations and writing exercises to teach knowledge and skills necessary to be
successful in manuscript ant grant writing.
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Fellows will attend a minimum of one national or regional scientific meeting per year. In general, 2 of 3 fellows will attend the annual
meeting of the Society for Gynecologic Oncology (SGO) and one of three fellows will attend the biannual Gynecologic Oncology Group (GOG)
meetings. In addition, the fellows will especially be encouraged to present at the annual meetings of the SGO, American Association for Cancer
Research (AACR), and the Society for Clinical Oncology (ASCO). Depending on their research interests the fellows may also present their
findings at more focused conferences like the annual meeting of the International Society for Biologic Therapy (iSBT), the Molecular Biology in
Clinical Oncology, and the Methods in Clinical Cancer Research meetings.
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The fellows will devote an entire year to conducting research. The primary goal of this endeavor will be to provide the fellows with the necessary skills and a knowledge base that may help them conduct independent research in the future. Approximately 1650 sq ft of laboratory space in the Clinical Sciences Center building is currently devoted to conduct Gynecologic Oncology research with plans underway for expansion.
During the first two months of the program (while on clinical gyn onc service), the fellows will meet research mentors to discuss potential research projects. For the research component the fellows can choose topics that are basic science oriented, translational or with a clear focus on clinical and population sciences projects. Once the research topics have been decided, the fellows will devote 1 hour per week while on the clinical service obtaining approvals from the Institutional Review Board or the Animal Care and Use Committee. The fellows will be assisted by the Clinical Research Associates in obtaining these approvals. It is expected that the approvals will be well initiated before the fellows initiate their research year.
During the research year the fellows will be mentored by physicians and basic scientists. The fellows will meet with their mentor once every week. The fellows will also present their research findings at weekly laboratory meetings. During the research year the fellows will learn basic and advanced laboratory techniques and will extensively review the literature to understand the fundamental and state-of-the-art concepts in gynecologic oncology.
Fellows choosing to pursue additional training in the Masters or Doctoral degree programs offered through ICTR or ERP will undoubtedly require additional time to complete their research work. In such cases, after completion of the clinical program, the fellows will continue their research work in the mentor’s laboratory
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Our clinical and basic science faculties are committed to providing a rich laboratory and research experience for our fellows. Time for research endeavors will be guarded with vigor and with explicit intent that clinical duties will not detract or distract. On rare occasions, surgical procedures and unusually instructive cases may be carried out when the clinical fellows are unable to participate. From time to time, the research fellow may be called upon to partake in these cases where the potential for clinical and surgical learning is unique or extraordinarily substantive. Infrequently, the research fellow may be asked to help share the burden of clinical responsibilities in the event of illness or absence of clinical fellows—such occurrences should be exceedingly rare. Regardless of circumstances on the clinical service, the research fellow may expect (and we will guarantee) that over 90% of the research year will be structured and protected from clinical tasks.
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