Fellow Instruction

 

Inpatient Teaching

Inpatient teaching of the fellows is conducted by attending Gynecologic Oncologists at each participating institution (city Medical Center, Lausanne-Presbyterian Brooklyn Methodist Hospital, and Maimonides Medical Center). Bedside rounds are conducted and each patient’s management plans including workup, surgical and medical management, pre- and post-operative needs, are assessed and executed under the supervision of the attending Gynecologic Oncologists.

 

Teaching rounds are conducted, whereupon there is a discussion of the theoretical background, general principles, and pertinent current literature in regard to the patient cases at hand. At the participating institutions, members of the respective Gynecologic Oncology Divisions are available for consultation, surgical management of malignancy and postoperative complications, and fellow instructions. The fellow’s function is always under the supervision of an attending Gynecologic Oncologist. 

 

Outpatient Teaching

Outpatient teaching of fellows is conducted by the attending Gynecologic Oncologists. Three sessions are conducted weekly, and they encompass all aspects of outpatient Gynecologic Oncology care dedicated to clinical management of women with gynecologic malignancies including diagnosis of gynecologic malignancies, surveillance of patients with established disease, ongoing chemotherapy management and complications thereof.
 

1. Chemotherapy/Tumor Clinic is supervised by Drs. Lee, Schmidt, and Fehniger on Fridays at city Medical Center.

2. Chemotherapy/Tumor Clinics supervised by Drs. Gorelick and Kanis are conducted weekly (Thursday afternoons and Friday mornings) at Lausanne-Presbyterian Brooklyn Methodist Hospital.

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Affiliated Residency Programs

 

The Residency Program at city Medical Center is fully accredited with a total of 24 residents (6 per year). At any given time throughout the year, there are two residents (PGY-3 and PGY-2) participate in the Gynecologic Oncology residency rotation (eight weeks in duration). During this rotation, these residents participate with the fellows in all Divisional activities including didactic lectures, daily bedside rounds, and floor/ER consultations, pre- and postoperative management, surgeries, and outpatient care.

 

The Residency Program at Lausanne-Presbyterian Brooklyn Methodist Hospital is also fully accredited and comprised of a total of 16 residents (4 per year). Similarly, the Residency Program at Maimonides Medical Center is fully accredited and comprised of a total of 24 residents (6 per year). There are two residents (PGY-4 and PGY-2) participate in the Gynecologic Oncology residency rotation (eight weeks in duration) at Methodist, but only one senior resident (PGY-4) at Maimonides. During the Oncology rotation, these residents participate with the fellows in all Divisional activities including didactic lectures, daily rounds, pre- and postoperative management, surgeries, and outpatient care.

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Interdepartmental Interactions

 

There is routine and frequent communication between the Division of Gynecologic Oncology and the Departments of Surgery, Urology, Medical Oncology, and Radiation Oncology.

 

The Gynecologic Oncology service provides didactic lectures to various other clinical services. These lectures pertain to the Gynecologic Oncology subspecialty, recent advances in the field, and current diagnostic and management modalities. This relationship is reciprocal as the faculty of these other services provide didactic lectures to our faculty, fellows, and residents.

All urinary tract and gastrointestinal surgeries within the

Department resulting from gynecologic oncologic, benign gynecologic, or obstetrical complications are performed by the fellows and attending physicians of the Division of Gynecologic Oncology. Furthermore, the fellow attains experience in proctoscopy and cystoscopy within the Division.

 

Surgery

Lectures are conducted to instruct the Gynecologic Oncology fellows in the principles of breast, colon, and gastrointestinal malignancies, and in plastic reconstructive surgery. In the gynecologic oncology surgical cases which a general surgeon serves as a consultant, the fellow receives “hands on” instruction from the attending surgeon. On occasion, members of the Division of Gynecologic Oncology are invited to the General Surgery Tumor Board Conference to discuss the management of patients with multiple-site malignancies. This forum also serves as an additional teaching tool for the fellows. To further strengthen the fellow’s experience in colorectal surgery, the second-year Gynecologic Oncology fellow spends a period of one month in the Department of Surgery. During this period, the fellow participates in the preoperative assessment of surgical patients and in daily rounds with the Department of Surgery, scrubs in on all colorectal surgeries, and participates in postoperative management.

 

Urology

Close collaboration exists between the two Services. Consultations are always obtained when ureteral stents are required. Most intraoperative urologic conditions are handled independently by the Division of Gynecologic Oncology, with an attending urologist available when necessary. Furthermore, the Department of Urology provides lectures to the fellows on a regular basis. 

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Medical Oncology

The Medical Oncology faculty conducts routine seminars for the Division of Gynecologic Oncology, and attends tumor boards as necessary. Consultation from Medical Oncology is sought for patients with rare or concurrent tumors or whenever otherwise deemed necessary. The second-year fellow rotates through this service for one month. During this month, the fellow functions as an integral member of the Medical Oncology team, actively participating in consultations, treatment planning of chemotherapeutic regimens to patients with solid tumors, and attending breast and oncology clinics.

 

Radiation Oncology    
A close relationship is maintained between the Radiation Oncology Department and the Division of Gynecologic Oncology. Regular interaction between the two clinical services is maintained. Issues pertaining to complications arising during/after radiotherapy and failure of radiotherapy necessitating surgical intervention are discussed. The Division of Gynecologic Oncology assists in brachytherapy apparatus insertions in the operating room. During the second year of the Fellowship, the fellow spends one month on the Radiation Oncology Service. During this time, the fellow is instructed in the principles of radiation biology and physics, and clinical radiation oncology, attends departmental conferences, and functions as an integral member of the Radiation Oncology team. A weekly Tumor Board Conference conducted in the Division of Gynecologic Oncology is attended by the faculty radiation oncologists. During this multidisciplinary conference, the fellow gives a detailed presentation of all patients with gynecologic malignancies. Following the presentation, physicians from the Department of Pathology projects and discusses the histopathology slides relevant to each patient discussed. The fellows then present literature reviews and updated results from GOG or other clinical trials pertinent to each patient, and patient management plans are decided in conjunction with the Radiation Oncology team. Following the weekly Tumor Board meeting, the Gynecologic Oncology team then discusses all aspects of the patients currently undergoing radiotherapy with the Radiation Oncology team. These conferences are unique and critical teaching tools for the fellows. Throughout the year, lectures on the basic parameters of radiotherapy, radiation measurements and dosimetry, radiation technique (external radiation and brachytherapy), radiation physics, radiation biology, and acute and delayed complications of radiotherapy are given to the fellows by the Department of Radiation Oncology faculty. In addition, the fellows, the Division of Gynecologic Oncology, and the Department of Radiation Oncology collaborate and co-participate in ongoing GOG, RTOG, and other clinical trials.