TOH FELLOWSHIP IN MINIMALLY INVASIVE GYNAECOLOGY

2017-2019

Program Synopsis:

The fellowship program in minimally invasive gynaecology has been developed to provide an opportunity for concentrated exposure and additional training for the next generation of OB/GYN graduates who wish to provide advanced surgical care in an academic and clinical setting. The fellows will receive sub‐specialty training and technical competency in sophisticated gynaecological endoscopic procedures that can be used for treatment of complex benign gynaecologic conditions.

The program directly addresses the concerns of graduating OB/GYN trainees and program directors, which state that further training opportunities are required in operative laparoscopy, hysteroscopy, and advanced pelvic surgery (Raymond et al, JMIG 2005). The curriculum has been designed to contain two portions; an extensive clinical section and an advanced surgical education component, permitting the fellows to effectively develop a strong foundation within academic gynaecologic surgery.

The fellowship has two main overall objects: 1) to develop clinical expertise in advanced gynaecologic surgery; and 2) to develop expertise in surgical education and simulation.

Through the development of a structured program, focusing on advanced gynaecologic endoscopy surgical skills and training in surgical education, this fellowship is able to offer an experience that will graduate skilled surgeons and academic leaders.

Program Director:

Dr. Sukhbir Sony Singh MD, FRCSC

Assistant Professor

Director of Minimally Invasive Surgery

Shirley E. Greenberg Women’s Health Centre

Department of Obstetrics and Gynaecology

University of Ottawa/The Ottawa Hospital

Program Co-Director:

Dr. Karine Lortie MD, FRCSC

Assistant Professor

Surgical Education Director

Department of Obstetrics and Gynaecology

University of Ottawa/The Ottawa Hospital

Program Outline

Fellow Expectations:

1. Clinical Expert:

  • Become advanced gynaecologic surgeons with proficiency in operative laparoscopy, hysteroscopy and major complex vaginal and open surgeries
  • Become knowledgeable in not only the surgery, but the “surgical philosophy”

2. Communicator:

  • Become a surgical educator: mentor and teach residents, students and practicing colleagues

3. Health Advocate and Leader:

  • Patient counseling: create and disseminate peri-operative information for patients
  • Program developer: create, implement and evaluate patient care programs in minimally invasive gynaecologic surgery

4. Scholar:

  • Develop an independent research question and complete at least one project
  • Present this project at a national or international conference
  • One research publication (or at minimum, a manuscript suitable or publication), two review articles, or two case reports/video presentations is expected to be completed by the time of their graduation

Fellowship CORE Outline:

General Template – Year 1 – Surgical/Clinical

Monday / Tuesday / Wednesday / Thursday / Friday
Grand Rounds / CIVIC Rounds / GEN Rounds
AM / Research / OR – General Campus
or
1x/month chronic pelvic pain clinic / MIS Hysteroscopy Suite
or
OR – Civic
or
OR – General / OR – Civic Campus
OR
MIS Clinic / OR – General Campus
or
Hysteroscopy Suite
PM / MIS Clinic
Other / Animal and Dry Lab for Resident Training

General Template – Year 2 – Surgical Education

  • Associated with HESP and AIME
  • Weekly lectures on surgical education, research methods
  • Weekly surgical education simulation sessions

Elective Opportunities (1 month):

  • Urogynaecology / Pelvic Pain Reconstruction
  • General Surgery
  • Urology / Cytoscopy
  • Chronic Pelvic Pain Clinic

The Ottawa Hospital Department of Obstetrics and Gynaecology

A tertiary care centre affiliated with the University of Ottawa. The Ottawa Hospital has an academic mission that includes the advancement of minimally invasive surgery across all specialties. New operating theatres opened in 2008 with state of the art surgical suites and equipment. The MIS Gynaecology program offers a tertiary level referral practice for complex benign cases which include severe endometriosis, uterine fibroids, infertility and pelvic prolapse.

At present, we have four fellowship mentors to provide a wide range of approaches and experiences across the specialty of gynaecology.

In addition, the fellows have access to the resources at the University of Ottawa Skills and Simulation Centre where there will be hands on training sessions, and simulation sessions on the numerous procedures that they will face in their career. Moreover the uOSSC records all the simulated procedures, allowing the fellows to evaluate their own performance.

Fellowship Objectives:

(Complete technically and knowledge competencies for gynaecologic endoscopy training available)

The program is structured in such a way that it begins by focusing on reinforcing a clinical and educational foundation for the fellows, and then subsequently immerses them in independent research and advancement of their surgical skills.

Clinical Objectives:

The objective is to allow the fellow to become a clinical expert within this field, advancing their skills to that of an advanced gynaecological surgeon with a proficient understanding in operation of laparoscopy, hysteroscopy, and major complex vaginal surgeries, and to have the ability to act confidently in surgery. Next, we wish for our fellows to become communicators allowing them to act as surgical educators, and to teach and mentor students and colleagues. An overall objective for any sub‐specialty program is to have fellows that grow to be health advocates and scholars. Our fellows will be capable of patient counseling and program development in which they will be knowledgeable about the indications, contraindications, complications and alternatives to endoscopic surgical treatments.

Research Objectives:

They will be required to develop an independent research question and complete at least one project during year I, as well as present this project at a national or international conference. Our goal is to offer our fellows valuable experience in clinical research development.

The fellows are expected to have at least one research publication (or at minimum a manuscript suitable for publication), two reviewarticles or two case reports/video presentations by the time of their graduation.

Educational Objectives:

Teaching of our residents/staff is a significant part of our program. Fellows will learn and practice teaching in didactic, simulation and laboratory sessions. The program is well developed and our fellows are well appreciated for their skills and time in education.

Training Key Components:

  • Detailed pelvic anatomy as required for complex surgery
  • Comprehensive understanding of energy sources (electrosurgery, alternative energy sources)
  • Safe entry techniques for creation of pneumoperitoneum
  • Fundamentals of endoscopic surgical set-up
  • Hysteroscopic techniques – ablation, myomectomy, polypectomy
  • Surgical management of adnexal pathology
  • Surgical management of endometriosis including severe endometriosis
  • Techniques of laparoscopic hysterectomy
  • Ureteric dissection
  • Prevention and management of complications related to endoscopic surgery
  • Pre-operative and post-operative management and counseling skills

Evaluation of trainee performance:

While each fellow will have direct, yet informal, feedback from their colleagues and supervisors after any case/clinical work or learning experience, formal evaluations and feedback will be done on a quarterly basis. This evaluation will include the Objective Structured Assessment of Technical Skills (OSATS) global rating system to evaluate the fellow, as well as have specific questions on the key training components of this program(medical expert, communicator, collaborator, manager, etc) depicting whether the fellows did or did not meet the expectations for that level, and as well overall/general questions to allow for positive feedback and constructive criticism. Moreover, at the end of the fellowship program, he or she will receive a written report recognizing clinical fellowship completion consisting of any comments or feedback.

Fellowship Infrastructure:

  1. Fellow Office – Shirley E. Greenberg Women’s Health Centre, 7th floor
  2. Surgical Experience – cross campus experience at TOH
  3. Major Surgical Cases – General and Civic Campus
  4. Minor Surgical Cases – Riverside Campus
  5. Outpatient “office” procedures – Shirley E. Greenberg Women’s Health Centre, 7th floor MIS Suite
  6. University of Ottawa Skills and Simulation Centre
  1. Research Support
  2. Shirley Greenberg Women’s Health Centre, 7th floor Research Unit
  3. Gynaecology Health Research Unit, Department of OB/GYN
  1. Educational rounds/courses
  2. Advanced Pelvic Surgery Rounds – Civic Campus
  3. Minimally Invasive Gynaecology Rounds – General Campus
  4. Resident Teaching – surgical anatomy, laparoscopy/hysteroscopy
  5. MIS Lab for OB/GYN residents
  1. Conference Support
  2. Attend AAGL annual world congress (November, US city)
  3. Attend a national conference (ex. SOGC)

Fellowship Duration: 2 years

Fellowship Salary: TBD (opportunity for locum call available)

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TOH Fellowship in MIS Gynaecology