Gynecologic Oncology Training
- Renata Urban, MD (University of Washington)
- Chirag Shah, MD (Swedish Medical Center)
The gynecologic oncology education and clinical training for the ObGyn residents is especially rich because of the broad exposure to operative and ambulatory gynecologic oncology at two institutions; the Gynecologic Oncology fellowship program; and referrals from the WWAMI region (Washington, Wyoming, Alaska, Montana, Idaho). Both of these rotations allow for diverse surgical training in open and minimally invasive surgery, including robotic-assisted laparoscopic surgery. At both clinical sites, there is a focus on education with weekly educational topics that are covered weekly at both sites. Tumor Board and Patient Care conferences, and quarterly journal clubs hosted by the Gyn Oncology faculty in their homes. Residents meet with faculty at the beginning of the rotation to concent to the educational and technical objectives, and they meet at the end of the rotation to review achievement of these goals.
At the University of Washington, the Gynecologic Oncology service is comprised of the GynOncology fellow, OB Gyn residents (PGY-4, PGY-2, PGY-1) and Anesthesiology resident (PGY 1) and is supervised by 7 full-time Gynecologic Oncology faculty.
- The PGY-1 participates in all surgical, medical and chemotherapy admissions, as well as working side by side with an attending in the clinic to evaluate new consults and perform preoperative counseling; the PGY-1 is also included in surgical cases to start developing their laparoscopic skills. The PGY-1 shares weekend call for the service with an Anesthesia PGY-1, who is a part of the inpatient team.
- The PGY-2 is included in all major cases, with the intent to improve skills in operative laparoscopy and open hysterectomies, as well as participation in outpatient evaluations with the attending.
- The PGY-4 is also included in major open operative cases as well as laparoscopic and robotic staging. The fellow and PGY-4 alternate home call on weekend, as well as share responsibility for teaching rounds, inpatient care, and the care of the critically ill.
The rotation includes a weekly Pathology conference, during which residents participate in multidisciplinary treatment conferences and includes colleagues from Pathology and Radiation Oncology. In addition, the team is part of a weekly conference that includes pharmacists, social workers, nutritionists and nurses, with the goal of improving patient care coordination. The University of Washington is affiliated with the Seattle Cancer Care Alliance (the outpatient clinic site where residents/faculty provide pre-/post-operative care for women with gynecologic cancers) and the Fred Hutchinson Cancer Research Center.
At Swedish Medical Center, one of the largest private hospitals in the Seattle metropolitan area, the gynecologic oncology team is composed of a PGY-1, PGY-4, and a GynOncology fellow and is supervised by 6 full-time Gynecologic Oncologists and 2 Gynecologic Surgeons. The surgical volume at this site is high, leading to a very broad surgical experience for the PGY-4 and PGY-1 as residents take part in the majority of the surgical cases which occur every day of the week. Many of the operative cases at Swedish are performed via robotics or laparoscopy, which complements the residents' training in minimally invasive surgery. The Swedish Gyn Oncology faculty are dedicated to the education of the UW ObGyn residents and fellows, working with the UWMC faculty to achieve educational objectives, participating in GynOncology Journal Club, and covering clinical services during resident education time every Wednesday morning from 8 AM-noon.
The Gynecologic Oncology faculty at both institutional sites are active in clinical care, medical education, and research, including mentoring residents/fellows in research and for fellowship. Residents are welcomed to participate in both clinical and translational projects; as recently as 2010, residents have presented their research in Gynecologic Oncology at national and regional conferences.
Gynecologic Oncology Program Guidelines
The UWMC Gyn Oncology rotation consists of one 7-week block of inpatient and ambulatory clinical experience during the R1 year. These clinical and education duties are shared between the PGY 1 OB Gyn and Anesthesiology residents. The Gyn oncology fellow should be notified of all admissions, transfer to the ICU, or any emergent post op complications.
The Swedish Gynecology rotation consists of one 7-week block that is primarily a surgical rotation. The PGY-1 operates as a first assistant and/or primary resident surgeon on Gyn oncology surgeries and benign gynecologic surgeries. Inpatient care is shared between the R4 and R1 and supervised by the Gyn Oncology fellows and Swedish Gyn Oncology faculty. R1 should never take home call on Swedish Gyn during the first half of the year and NO MORE than 1 night during the 2nd half of the year ONLY with Gyn Onc Fellow back-up to go into the hospital if needed (ie. R1 Swe takes only the phone calls no more than 1 night per wk to assist with potential fatigue issues for the call team but if evaluation, surgery required, the fellow or PGY-4 are expected to go into the hospital).
PGY-1: The R1 is exposed to Gyn Oncology on two primary services for 8 weeks each (UWMC and Swedish Gyn Oncology Rotations) in addition to covering the Gyn Onc postoperative patients during night and weekend call while on other rotations. The R1s main responsibility is:
- Learn evaluation of presumed and confirmed gyn cancers (SCCA clinics)
- Perform preoperative admissions and postoperative care (routine and recognize complications)
- Management of the unique needs of geriatric patients
- Learn to be a competent assistant and begin to learn to be the primary surgeon on routine surgical cases and laparotomies
PGY-2: The R2 is exposed to Gyn Oncology on the 8 week UWMC Gyn Oncology rotation. This is primarily an inpatient and surgical rotation. By the end of the 8 weeks on UWMC Gyn Onc, the R2 should be comfortable caring for geriatric patients and their co-morbidities as it relates to surgery, initial management of gynecologic oncology diseases, and recognizing/managing common postoperative complications and performing major abdominal and pelvic surgeries. The R2s main responsibility is:
- Assisting at major surgical procedures
- Learning anatomy and basic surgical technique
- Understanding the rationale for decision-making in relation to disease management
- Be familiar with the major reproductive tract cancers and the pathology of these diseases as outlined in the educational objectives to follow
- Assist the R1 with inpatient care, both pre-operative admissions and post-operative care, with guidance from the Gyn Onc faculty, fellow, and R4 as well as attend some clinics at the Seattle Cancer Center Alliance (SCCA).
PGY-4: The R4 is exposed to Gyn Oncology on two primary services (UWMC Oncology and Swedish Gyn) in addition to covering the Gyn Onc postoperative patients during night and weekend call while on other rotations. The R4 on these two services is primarily responsible for:
- Timely weekly submission of cases for M&M conferences and these should include both inpatient, consultations, and surgical cases
- Receive ER consult calls on Mondays and Friday AM- If the R4 Gyn Onc is unavailable during conference or surgery or SCCA clinic, he/she should delegate to R2 Gyn Onc if available OR to R4 Urogyn resident to see the pt and provide timely consultation. COMMUNICATION and working together as a resident team rather than rotation silo is important for good patient care
- Gyn oncology inpatient care, admissions, postoperative care and management of complications by providing oversight and delegation of clinical duties and surgeries with input from fellow and faculty
- All aspects of patient care, team work hours, teaching on these services, and provide leadership for the lower level residents and medical students
- Learn how the histo-pathology relates to treatment and prognosis of the various types of Gyn cancers by attending the Friday AM pathology conference, patient care conference, and 1:1 sessions with Dr. Rochelle Garcia (Pathology)