In-Depth Clinical Training for Gynecologic Oncology Fellows in All Aspects of Patient Care
Years two and three of the University Hospitals Gynecologic Oncology Fellowship are devoted to in-depth clinical training. The clinical fellows are involved in all aspects of the care of patients with gynecologic malignancies, including:
- Outpatient evaluation and follow-up
- Chemotherapy and radiation therapy
- Post-operative care
- Intensive care
- Palliative care
Progression of responsibility in any training program will be a central goal of the training program. This concept applies to many domains, including:
- Decision-making in the inpatient and outpatients settings
- Functioning and leadership in the operating room
- Role as educator
- Functioning and leadership of an integrated multidisciplinary oncology team
Gynecologic Oncology Main (GO1) Rotation
This rotation involves participation in relevant surgeries and managing their subsequent postoperative care, as well as assisting in the care of patients admitted to the hospital for acute problems, for chemotherapy, and for palliative care. All surgical cases and inpatients are managed primarily by the faculty members of the division, and the fellow is educated through each patient contact during surgeries and daily rounds. Each day, gynecologic oncology faculty member holds bedside teaching rounds with the team and a treatment plan for the day is established through dialogue in this setting. The team includes:
- The fellow
- Medical students
- The patient’s primary nurse
- UH Seidman Cancer Center patient care coordinator
- UH Seidman Cancer Center gynecologic oncology social worker
New inpatient consults are likewise evaluated by the fellow and resident team with subsequent faculty input in a similar fashion. The fellow will be responsible for having a comprehensive understanding of the oncologic, medical and social issues of each patient on service. They will also have a pivotal leadership role on the gynecologic oncology service in which they will oversee the activities of two residents, medical students, and two nurse practitioners, in addition to playing a pivotal role in communication with faculty, pharmacy staff, nursing and other ancillary personnel.
Fellows also spend five months during the two clinical years off service on rotations in:
- Colorectal surgery
- Radiation oncology
- Surgical critical care
Gynecologic Oncology Outpatient/Offsite (CO2) Rotation
While optimizing surgical experience is essential, some of the most important clinical decisions that a gynecologic oncologist makes in their daily practice are in the outpatient setting. The Gynecologic Oncology Outpatient/Offsite (GO2) rotation will serve to provide a focused outpatient experience for fellows-in-training. Fellows on this rotation will participate in clinics with the four gynecologic oncology faculty at UH Seidman Cancer Center as well as satellite UH Seidman Cancer Center locations at UH Westlake Health Center and UH Chagrin Health Center. Fellows will see patients independently, gather relevant background information and present them to the attending, who will examine the patient with the fellow. Following examination, fellows will participate in the review of imaging studies and clinical materials and discuss treatment planning for each individual patient with the attending.
Outpatient Chemotherapy Training
Most chemotherapy is administered in an outpatient setting, and the GO2 fellow will be immersed in the practical application of chemotherapy by participating in continuity care of our patients on active treatment. Through these interactions, the fellows will gain an understanding of chemotherapy indications, dosing, administration and toxicity management. Some patients will be considered for clinical trial participation and fellows will also gain an important understanding of the process of informed consent and clinical trial enrollment in this setting. Moreover, the pharmacists at the satellite cancer centers located close to the clinic/infusion centers, and the GO2 fellow will work with the pharmacists to gain their perspectives on chemotherapy administration, preparation, and cost.
Surgical Training During GO2 Rotation
To optimize the available surgical experience, when opportunity for fellow-appropriate surgical cases arises (i.e. endometrial cancer staging, ovarian cancer debulking, bowel resection, radical hysterectomy, radical vulvectomy, exenteration, etc), the fellow will also be engaged in surgery during the GO2 rotation. This is anticipated when fellow-appropriate cases are scheduled at off-site locations (ie. Southwest General Hospital and St. John Medical Center), or when premium fellow-appropriate surgical cases are occurring concurrently at UH Cleveland Medical Center Main Campus and cannot be adequately covered by the GO1 fellow.
Surgical Training Portfolio
The research and clinical training for fellows is augmented by a comprehensive education and didactic program. The Surgical Training Portfolio was designed and implemented to enhance the efficiency of surgical training through optimization of trainee preparation and by providing a mechanism for consistent and timely feedback. Fellows participate in the OB/GYN Department Clinical Service Review Conference and present yearly at Grand Rounds. They organize and conduct the weekly Gynecologic Oncology Tumor Conference and present monthly progress reports on research activities, and attend the biweekly core curriculum didactic series. Fellows are also supported to attend and participate in scientific meetings.