The Fellowship Program in Gynecologic Oncology at Massachusetts General Hospital
The Massachusetts General Hospital offers a three-year gynecologic oncology fellowship program that provides physicians interested in specializing in clinical and surgical gynecologic oncology with a robust learning experience. One fellow is chosen annually for this program.
The MGH Gynecologic Oncology Fellowship program offers trainees the opportunity to become fully immersed in the care of patients with reproductive cancers. Working with colleagues throughout the Department of Obstetrics and Gynecology, the MGH Cancer Center and other departments within the Massachusetts General Hospital, fellows will have the opportunity to provide surgical and clinical care for patients in these and other departments. During the three year fellowship program, the gynecologic oncology fellow will:
1. Develop expertise in the management of complex and radical pelvic surgery
2. Develop expertise in the management of small and large bowel surgery
3. Develop surgical expertise in the management of urologic involvement by pelvic tumors and expertise in the management of vascular injury of the pelvis
4. Develop expert knowledge of state-of-the-art chemotherapy in the management of gynecologic cancers
5. Develop expert knowledge of the state-of-the-art radiotherapy in the management of gynecologic cancers
6. Develop expert knowledge in gynecology pathology
7. Provide comprehensive pain management for gynecology oncology patients
8. Develop an understanding and expertise in the management of the consequences of therapy for gynecologic cancers, including an understanding of sexual dysfunction, urinary and bowel dysfunction
9. Be exposed to and participate in basic science research
10. Participate in local and nationwide clinical research
The strengths of this program lie in its patient volume and the complexity and range of diseases treated on the service and in the comprehensive, vertically integrated approach to the patient in which the fellows carry out total primary care of the cancer patient. Although, we have an active consultative relationship with our allied services, urologic and general surgical procedures, as well as chemotherapy, are directly managed by the fellows. We continue to expand our base of referral practice to multiple hospitals and regional medical centers in Massachusetts, and in the New England area to ensure the flow of patients for exposure in training and research. The fellows do not travel off-campus to participate in the care of patients as, to-date, all services are centralized at the Massachusetts General Hospital.
Eligibility for this fellowship requires satisfactory completion of an A.C.G.M.E. or R.C.P.S.C. approved residency in Obstetrics and Gynecology, successful completion of the written examination of The American Board of Obstetrics and Gynecology, and eligibility for a license to practice medicine in the state of Massachusetts.
EDUCATIONAL PROGRAM AND ORGANIZATION OF INPATIENT AND OUTPATIENT TEACHING.
The most effective teaching technique has been one-on-one teaching between faculty and fellows during inpatient rounds and in the operating room. In addition to direct hands on teaching and guidance, there are several didactic conferences as described below. Supervision of the fellows in the ambulatory setting comes from the five staff gynecologic oncologists. In addition, our colleagues in medical oncology, pathology, interventional radiology, and radiation oncology play a role in clinical teaching and in conferences. In the operating room, the supervisory surgeon provides a progressively increasing experience for the fellow. The rate of progression varies with the abilities and the experience of the individual fellow, who is expected to be able to deal independently with the range of difficulties encountered in the surgical management of these outpatients with gynecologic cancer.
Didactic conferences occur every day of the week and involve formal teaching by all members of the service.
The Monday morning Journal Club is run by the fellows to highlight important articles, critically review methodology, and explore current controversies in the management of gynecologic cancer.
The Tuesday morning GYN Conference is also attended by the benign gynecology team to present a focused slide presentation on a pre-assigned topic. The Vincent Center for Reproductive Biology (VCRB) meeting takes place Tuesdays at noon.
The Wednesday morning Tumor Board Conference is a forum wherein fellows are expected to present all new gynecologic cancer surgical patients and provide an evidence-based recommendation by citing from the literature when appropriate. Following Tumor Board, a didactic lecture is given by a rotation of Division faculty, ancillary medical experts in Nutrition, Cardiology, Anesthesia or other disciplines, and invited gynecologic oncology faculty from outside Mass General.
Thursday mornings consist of formal resident case presentations and Departmental Grand Rounds. The Challenging Case Conference occurs Thursdays at noon to provide a regular multidisciplinary forum for particularly complicated patient care management.
The Friday morning Chemotherapy Protocol Conference reviews regional and national trials open within our research consortium, specific challenges on protocol, and complications of chemotherapy.
Other monthly educational meetings within the Division include the Gynecologic Oncology Chemotherapy Conference, the Morbidity & Mortality Conference, and the Gynecologic Oncology/VCRB Research Conference.
Additional monthly conferences combine the varied experience of faculty from Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel-Deaconness Medical Center, and the Dana Farber Cancer Institute. New clinical trial concepts are reviewed at the Dana Farber/Harvard Cancer Center Research Meeting and fellows are strongly encouraged to develop their own proposal. The Dana Farber/Harvard Cancer Center Gynecologic Oncology Basic/Translational Seminar Series merges the clinical care of patients with cutting edge laboratory research.
Academic productivity is strongly encouraged through effective mentoring, statistical assistance and the opportunity to submit abstracts to a wide variety of national and international meetings. The second and third year fellows are required to attend the annual Society of Gynecologic Oncology meeting. All three fellows are required to attend the New England Association of Gynecologic Oncologists meeting while one faculty member holds the beeper and covers the service. The senior fellow is required to attend the Gynecologic Oncology Group meetings for further education in the development of clinical trials. Program faculty actively participate in these venues, helping to provide an opportunity for fellows to establish a focused career with national visibility.
Fellows have the opportunity to develop their clinical and surgical skills through a structured program of progressive responsibility.
The clinical experience begins in the second year when the fellow is responsible for the gynecologic oncology inpatient service. The fellow conducts morning rounds with the team of residents, students, and NPs, and makes all decisions about the day-to-day management of inpatients, and writes the chemotherapy orders as indicated. The covering faculty of the week provides oversight and teaching during a daily roundtable. The fellow also fosters a collaborative environment to integrate Case Management, Pain & Palliative Care, and other consultants. The third- year fellow is responsible for the gynecologic oncology consult service.
Both fellows are in the operating room on a daily basis to hone their surgical skills with a broad spectrum of experience provided by the Division faculty. The expectation is that the fellow with develop their skill set to function independently by the end of their training. The combined expertise of the faculty provide robust exposure to laparoscopic, robotic, and open techniques – including innovative procedures such as laparoendoscopic single-site (LESS) surgery and laparoscopic extraperitoneal lymphadenectomy. Additionally, the faculty are privileged to routinely perform ultra-radical upper abdominal procedures to achieve an optimal result during cytoreduction of advanced ovarian cancer.
The second-year gyn onc fellow attends one monthly session of Colposcopy Clinic, performs loop excisional procedures as indicated, and is expected to learn the current management of cervical dysplasia.
The third-year gyn onc fellow attends one clinic session per week with Division faculty on a rotating basis to have comprehensive exposure to the evaluation of new patients, pre-operative counseling, post-operative visits, and surveillance. The fellow is also expected to write chemotherapy orders for patients on clinical trials or receiving standard regimens. Evidence-based decision-making is emphasized and discussed in real time with Division faculty.
The first-year gynecologic oncology fellow has a year of protected time to perform comprehensive laboratory research and develop a thesis project under the direct supervision of Division faculty Bo Rueda, PhD, and Rosemary Foster, PhD. The Vincent Center for Reproductive Biology is located on the Mass General main campus. The lab space includes independent investigators, post-doctoral students, other clinical fellows from subspecialties within the Department of Obstetrics & Gynecology, research assistants and lab technicians. The research efforts are centralized within the department to provide a collegial environment.
The laboratory emphasis is cutting-edge preclinical drug testing on xenograft models to develop novel agents for transition to a clinical trial in humans. Division faculty Whitfield Growdon, MD, also provides oversight to the fellow’s work, while conducting his own translational research in the VCRB. The first-year fellow is expected to develop skills in grant writing, manuscript preparation, and presentation of results at regional and national meetings. The first year fellow is expected to complete two graduate courses as required by ABOG. The program is privileged to provide access to high-quality courses offered through the Harvard School of Public Health.
The second- and third-year fellows have the opportunity to mine division databases for clinical topics, prepare trial concepts for presentation at the Gynecologic Oncology Group semi-annual meeting, mentor residents on clinical topics, and work on other research projects with Division faculty.
There are presently two off-service rotations that provide additional expertise for the clinical fellows.
One month is spent with Tim Russell, MD, chief of Gynecologic Radiation Oncology, during which time the fellow is required to be involved in all outpatient high dose-rate implants, attend a series of structured lectures by the radiation oncology staff, and attend dosimetry planning sessions. Dr. Russell serves as the co-chair of the NCI-Cervical Cancer Task Force, is a frequent program director for post-graduate courses within the SGO, and is nationally recognized for his clinical expertise and academic contributions. The educational goals for radiation oncology adhere closely those provided in the ABOG Guide to Learning in Gynecologic Oncology.
The second off-service rotation is a Gynecologic Pathology rotation offered in combination with Brigham & Women’s Hospital on an annual basis. This involves a week of post-graduate course material. The fellow is also required to attend sign-outs and conferences in pathology and cytology to provide sufficient immersion for a comprehensive, focused experience.
RESPONSIBILITIES AND ACTIVITIES OF FELLOWS IN TEACHING:
The second year fellow is charged with fostering an informal teaching environment with the clinical service team: one third year resident, one intern, 1-2 third year Harvard Medical Students (HMS), 0-2 sub-interns from HMS or another medical school, and a nurse practitioner. The fellow also organizes didactic topics for weekday morning conferences.
The third year fellow is expected to present the Division Morbidity and Mortality data during Departmental Grand Rounds on a quarterly basis. The fellow is also charged with organizing the Wednesday didactic lectures series.
Both fellows are expected to provide a robust teaching experience for residents and students in the operating room under the direct supervision of Division faculty. The program is privileged to be consistently recognized for excellence by the integrated residency at Mass General/Brigham & Women’s Hospital.
Contact: Joan McGurn, Gillette Center for Women's Cancers