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Reproductive Endocrinology and Infertility Fellowship: Program Curriculum |
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Residency & Fellowship Programs > Obstetrics & Gynecology > Reproductive Endocrinology and Infertility Fellowship: Program Curriculum |
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The fellowship provides protected time for clinical education and research development. The first year is dedicated to patient care in the areas of infertility, reproductive endocrinology, and endoscopic surgery (90% clinical, 10% research time). The fellow works one-on-one with each of the six Board-certified Reproductive Endocrinologists in the outpatient clinic setting. The surgical emphasis is on operative laparoscopy and hysteroscopy, with over 150 cases performed each year. The fellow also learns outpatient procedures including sonohysterography, hysterosalpingography, follicular monitoring, and transvaginal ultrasound for gynecologic disorders. All clinical activities are performed at Fletcher Allen Health Care. During the second half of the year, the fellow builds his/her own clinical and surgical practice with the guidance of the faculty. The first year fellow will also select and develop a clinical research project. All fellows participate in a weekly 1½-hour didactic session and a 1½-hour clinical teaching conference. The first year of the program is primarily clinically oriented. The first half of the year, the fellow works closely with each of the attendings in Reproductive Endocrinology to allow one-on-one training in the clinical aspects of the field. During the second half of the year, the fellow takes primary responsibility for a cohort of patients identified as his or her own in the clinic, and plays a key role in the management of the overall clinic population. During this year, the fellow supervises all aspects of the division's activities in infertility and endocrine evaluation and management, except for those related directly to IVF. The first year fellow is in the operating room during both operating days of the division, and is given primary surgical responsibility in all cases. Approximately one-third of the fellow's time is spent in each area of the specialty: infertility, reproductive endocrinology, and reproductive surgery. Care of couples with primary and secondary infertility includes the initial evaluation, interpretation of laboratory tests, and performance of diagnostic procedures including sonohysterography, hysterosalpingograms, and transvaginal ultrasound. As the only Reproductive Endocrinologists in our region, our group receives numerous referrals for pediatric endocrinology, amenorrhea, hirsuitism, hyperprolactinemia, and menopausal problems. In the operating room, endoscopic and microsurgical techniques are stressed. Opportunity is provided to learn and practice these innovative procedures both in the laboratory and the operating room. Statistics is taken the first half of the first year. These skills are considered fundamental to critical reading of current literature and to research study design, and are intended to be acquired as early as possible in the fellowship. The fellow will develop a project in clinical research during the second half of the first year with the mentoring of the faculty. This endeavor should capitalize on questions originating from first-hand exposure to problems in clinical management. The fellow has an appointment as Clinical Instructor at the University of Vermont and obtains hospital privileges at the academic medical center, Fletcher Allen Health Care. This recognizes the role of the fellow as a junior member of the faculty and their role in resident and student education. The fellow participates in general Obstetrics and Gynecology night-call house coverage schedule (in-house call), with one in-house call required per month. The fellow may elect to take additional call as a generalist OB/GYN for additional compensation (above the baseline salary), but only one call night per month is required. The first year is the most formally structured of the three years, and has the least free time. The goal is to prepare the fellow to manage most clinical problems in the field. With the commencement of the second year, most clinical responsibilities cease. First Year Fellow's Schedule Monday Tuesday Wednesday Thursday Friday The second year of the fellowship offers protected time for development and completion of the basic science project (90% research, 10% clinic time). The fellowship director, Dr. Peter Casson and the Research Division, headed by George Osol, Ph.D., assist the fellow in selecting and conducting the research. The research faculty throughout the College of Medicine are available to provide guidance to the fellow. In addition, the fellow will continue work on the clinical research project selected during the first year. One half day each week is spent in a continuity clinic for the fellow's clinical practice. The second year fellow is focused on research and has limited obligations in the outpatient clinic. However, the fellow spends one half day per week in a continuity clinic to maintain clinical skills. The fellow may elect to participate in procedures and surgeries with his/her own patients, but is strongly encouraged to relinquish all other clinical activities to the new first year fellow. The second year fellow's freedom is applied to the design and execution of projects in basic and clinical research. Fellows are encouraged to work with departmental faculty or with other faculty in the insitution. The Fellowship Program Director is committed to working with each fellow to design basic and clinical projects that are publishable and fundable. The Research Division, headed by George Osol, Ph.D., is also committed to the research education of fellows. Financial support is available to cover the costs of fellow research in new areas. Fellows are also asked to develop applications for competitive funding during the second year. The clinical research project initiated during the first year is continued or completed in the second year. A full-time research nurse coordinator is available to assist fellows with recruitment and monitoring of clinical subjects, and a Clinical Research Center (CRC) is active at the academic medical center. The second year fellow is expected to exert leadership in the teaching activities within the division (conference and journal club schedules), and to take at least one additional university course at the graduate level. Participation in conferences sponsored by Medical Endocrinology is also encouraged. Second Year Fellow's Schedule Monday Tuesday Wednesday Thursday Friday Back to Top During the third year, the fellow sees all IVF patients, gains skills in medical and pediatric endocrinology, and completes the clinical and basic science research projects. Approximately one half of the fellow's time is spent in clinical activities and one half in research. The fellow evaluates couples referred for assisted reproductive technologies, performs follicular monitoring, manages ovulation induction cycles, participates in oocyte retrievals and embryo transfers, and has the opportunity to work in the IVF laboratory. At the conclusion of the three-year program, the fellow is well trained in all aspects of reproductive endocrinology and infertility, and will have completed one clinical and one basic science research project. The third year fellow manages the care of patients in the Assisted Reproductive Technology program. Duties include patient screening, day-to-day management decisions (with faculty consultation), and ongoing review of program design and protocols. The fellow performs oocyte retrievals and embryo transfers. There is opportunity to work with the embryologists in the laboratory, assessing oocytes and embryos, preparing embryos for cryopreservation, and participating in intracytoplasmic sperm injection. The ART program currently provides exposure to approximately 100 IVF and 80 Injectable Gonadotropin cycles per year. This program is overseen by Peter Casson, M.D. The third year fellow continues his or her continuity clinic. In addition, the third year fellow spends one half day per week for three months in medical endocrinology, and on half day per week for three months in pediatric endocrinology clinic, with the attending physicians in the Department of Medicine and Pediatrics By the conclusion of his or her third year, the fellow will complete the clinical and basic science research projects. With approximately fifty percent of the fellow's time dedicated to research, there is adequate time to prepare studies for publication and submit papers prior to the completion of the fellowship. It is anticipated that the fellow will present his or her research at national meetings; this activity is supported by departmental funds. All fellows are required to complete their primary thesis prior to the end of the fellowship. Third Year Fellow's Schedule Monday Tuesday Wednesday Thursday Friday *Clinic IVF/ Injectable gonadotropins only (that morning) 1. Graduate level biostatistics is taken during the first academic semester of fellowship. 2. A graduate seminar course Special Topics in Obstetrics and Gynecology: Molecular Endocrinology of Female Reproduction (OB295) is a course that is administered by the Department of Obstetrics and Gynecology. 3. An additional graduate level course in the fellows area of research interest is strongly encouraged during the second year of fellowship. 4. Faculty and fellows conduct weekly didactic sessions/journal clubs. 5. Weekly clinical conferences, including surgical reviews and clinical cases, are conducted by faculty, fellows, residents, and staff. 6. The Department of OB/GYN holds weekly grand rounds, monthly gynecologic morbidity and mortality conferences, monthly research seminars, and monthly journal clubs. 7. Weekly medical endocrinology conferences are available for the fellows, and attendance is encouraged. The first year fellow is involved in all surgical cases generated by the faculty and by his or her own practice. In 2005-2006, the first year fellow performed the following cases: Laparoscopies 87 These cases include tubal reanastomosis, neosalpingostomies, ablation of endometriosis, laparoscopically assisted vaginal hysterectomies, hysteroscopic myomectomies, endometrial ablations, and resections of uterine septums. It is the goal of the fellowship that all fellows are well trained in the most current endoscopic surgical procedures. |
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