Gynecologic Oncology

Program Director: R. Kevin Reynolds, M.D.

Year Fellowship Began: 1971

Research Time: One year (first year)

How to Apply:

Application to the University of Michigan’s Fellowship Programs may be made through the Electronic Residency Application Service (ERAS). For more information on the ERAS application process, please visit their website at: http://www.aamc.org/students/eras/guideline/start.htm.

Please note the following NRMP numbers when selecting our program:

In addition to the application, please forward the following documents to ERAS:

In order to be considered for the interview process your completed application packet must be received by ERAS no later than May 15, 2008.

For further information regarding the application process, please contact:

Nancy Durbin
Fellowship Coordinator
University of Michigan Health System
Department of Obstetrics & Gynecology
L4510 Women’s Hospital
1500 East Medical Center Drive
Ann Arbor, MI 48109-0276

Phone: 734-615-3773
Fax: 734-764-7261
E-mail: nancydur@med.umich.edu

Curriculum:

Statement of Purpose
The gynecologic oncology fellowship is an American Board of Obstetrics and Gynecology (ABOG) accredited program of 3 years duration for obstetrician-gynecologists seeking supspecialty training leading to board certification for comprehensive treatment of women with gynecologic malignancies.

Statement of Goals
The comprehensive goal of the University of Michigan gynecologic oncology fellowship program is to train academic gynecologic oncologists who are outstanding clinicians, teachers, and research contributors. The clinical educational objective of the three year training program is to provide fellows with the necessary knowledge, skills and experience to independently manage all gynecologic cancer patients. Specific educational goals for each fellow include development of the following:

  1. Sufficient understanding, experience, and proficiency to perform radical pelvic surgery independently and to manage intestinal, urologic and vascular problems caused by gynecologic cancer or its treatment.
  2. Ability to plan and implement non-operative management plans for the care of associated medical conditions that affect treatment of gynecologic cancer patients and to obtain appropriate consultation when necessary.
  3. Sufficient understanding and ability to participate as a member of the team that plans and applies all forms of gynecologic radiotherapy, including brachytherapy procedures.
  4. Ability to select chemotherapy regimens for patients, administer drugs, and care for the toxic side effects of chemotherapy.

In addition, each fellow will be provided resources and experience to develop academic skills. Specific objectives for the teaching and research curriculum include the following:

  1. Ability to use appropriate methods and educational aids to teach medical students, residents, and allied health care professionals in clinical or classroom environments.
  2. Sufficient understanding and proficiency to complete laboratory-based and clinical research projects, in addition to development of collaborative skills with others that foster ongoing research activities.
  3. Ability to write scientific articles, and grant applications and to contribute in an academic setting.
  4. Resources and instruction sufficient to complete a thesis necessary for board certification.

Program Overview
The strengths of the fellowship training program in gynecologic oncology at the University of Michigan Medical Center (UMMC) begin with the faculty of the division.

The training program in gynecologic oncology was founded in 1971 by George W. Morley, MD, who established a tradition of clinical excellence that continues today.

Faculty
The division and the fellowship training program are under the direction of R. Kevin Reynolds, MD, who was promoted to this role in January 1998. He joined the faculty in July, 1991, after completing his fellowship at UMMC. He is recognized as an excellent surgeon and has won many awards for teaching. Dr. Reynolds has developed a minimally invasive surgery program at the University including conventional and robotic laparoscopy, and also has expertise in fertility sparing surgery as well as ultra radical procedures including the laterally extended endopelvic resection (LEER procedure). Carolyn M. Johnston, MD, is recognized as an excellent surgeon and clinician and an outstanding teacher. She is actively involved with clinical education of fellows. J. Rebecca Liu, MD, joined the division in July 1999 upon completion of her gynecologic oncology fellowship at the University of Michigan. She has a 20 percent clinical appointment and an 80 percent research commitment. Dr. Liu has been involved in clinical instruction of residents and fellows and in the guidance and instruction of the laboratory research phase of the fellowship. In August 2007, Angela Kueck, MD, joined the division as a clinical gynecologic oncologist. She has won teaching awards and is expert in minimally invasive surgical techniques. Anthony W. Opipari, MD, PhD, joined the division as a research scientist and clinician staffing the colposcopy clinic in July, 1998. His research in the field of small molecules regulating apoptosis pathways and targeted therapies has been very successful and well funded. Richard W. Lieberman, MD, joined the division in 1997. He holds a joint appointment in the Departments of Pathology and Obstetrics and Gynecology and is board certified in both disciplines. He is a consultant pathologist for the Gynecologic Oncology Group and is the pathologist for the UMMC gynecologic tumor board. He is actively involved in instruction of fellows and staffs the colposcopy clinic. Ronald Buckanovich, MD, PhD joined the division in July 2006. He is a medical oncologist with expertise treating gynecologic malignancies and leads a laboratory focusing on tumor angiogenesis. He is actively involved in clinical trial development and is actively mentoring fellows during the laboratory research phase of the fellowship

Resources
The UMMC includes over 30 buildings and 82 acres of land, making it the world’s largest single-site complex devoted to health education, research, and patient care. UMMC is one of the top medical centers in the nation, according to annual US News and World Report rankings. The clinical programs at the UMMC are uniformly of outstanding quality.

The University of Michigan established a cancer center in 1986 to provide quality patient care, initiate innovative research and treatment approaches, and offer trainees the most comprehensive education possible. The Cancer Center was designated as a Comprehensive Cancer Center by the National Cancer Institute in 1991. A state-of-the-art Cancer facility of 252,000 gross square feet opened in May, 1997. The Cancer Center includes dedicated space for the clinical and basic science activities of the Division of Gynecologic Oncology. These resources provide a unique educational environment for fellows in gynecologic oncology

The University of Michigan Comprehensive Cancer Center is supported by 280 faculty researchers who receive over $55 million dollars in grants each year from the National Institutes of Health and other agencies. Basic science research programs include Tumor Metastasis and Extracellular Matrix; Carcinogenesis; Molecular Oncology; Tumor Immunology; Cancer Pharmacology; Drug Discovery and Development; and Cancer Epidemiology, Causation, and Prevention. Clinical research oncology programs include Adrenal Cell; Breast; Cutaneous; Gastrointestinal (colorectal, pancreas, liver, stomach); Head and Neck; Leukemia/Lymphoma; Neuro-Oncology; Ocular; Pediatric; Radiation; Sarcoma; Thoracic, and Urology.

Strengths of the Program
Other strengths of the Division and the Institution that contribute to the quality of the fellowship training program in gynecologic oncology include:

Fellowship Training Structure
The fellowship is currently structured to provide one year of laboratory experience followed by two years of clinical training.

Research Year (Year 1)
The division objective for basic science research activity will focus upon the molecular biology of gynecologic neoplasms, specifically ovarian, and to a lesser extent, endometrial, myometrial and cervical cancers. The first year fellow is not assigned any clinical responsibilities and does not participate in the clinical call schedule. The educational objectives of the research year include the following:

These educational objectives are accomplished by providing a structured research experience in which the fellow is expected to devise and implement a research plan, interpret the results, trouble-shoot experimental failures, and prepare a manuscript describing the work.

The selection of the basic science research project is based upon input from the prospective fellow, the program director, and the project. The fellow can design his or her project after discussing the options with the program director and research mentor. If the fellow has a specific project in mind, every effort will be made to accommodate that interest. In special circumstances, clinical research projects will be considered acceptable. Examples include projects related to epidemiology or outcomes research that involve significant participation with the School of Public Health. The project that is selected must have scientific merit, be related to some aspect of gynecologic oncology, and have achievable goals. The activities of the research year are expected to result in at least one peer review publication.

The organization, focus and leadership of the basic science and clinical research efforts for the Division of Gynecologic Oncology have been significantly modified over the last few years and will continue to evolve. J. Rebecca Liu, MD, joined the division in July, 1999. She has an 80 percent allocation of her time to research and has secured several grants to fund her endeavors. Her research focus is on caspase mediated apoptosis pathways, identification of altered gene expression in ovarian cancer, and alteration of chemoresistance in ovarian cancer. She has been an enthusiastic participant for research education of the fellows.

Anthony W. Opipari, MD, PhD, joined the division as a Lecturer in 1998 and has is now an Associate Professor. He has secured funding from the N.I.H for an innovative project focused on development of a novel apoptosis triggering agent that may have potential as an antineoplastic drug. He has outstanding technical expertise in the laboratory and is widely respected for his keen investigative insight. Gary Glick, PhD, in the Department of Chemistry, is his research colleague.

Ron Buckanovich, MD, PhD, joined the department in 2006. He is a medical oncologist with extensive gynecologic cancer treatment experience. He has an independent lab focusing on angiogenesis pathway alteration in development of gynecologic malignancies. Beginning in 2007, he assumed a role in the laboratory and research traing for gynecologic oncology fellows. Dr. Buckanovich is also involved in development of investigator-initiated clinical trials.

Clinical Years (Year 2-3)
Fellows actively participate in all aspects of in-patient and out-patient care of patients with known or suspected gynecologic cancer, including evaluation, planning, treatment and follow-up. Structured in-patient and out-patient services incorporate the participation of gynecologic oncology fellows in all patient care activities. Faculty consultation is available to the fellows at all times. Formal teaching rounds at UMMC are conducted five times each week by Drs. Johnston (Mondays), Liu (Wednesdays), Kueck (Thursdays) and Reynolds (Fridays). Teaching rounds on Saturday are made by the on-call attending. The attending faculty agree that day-to-day patient care decisions will be left to the fellow as appropriate for the individual fellow’s level of training and experience.

The role of a fellow in a particular procedure is dependent upon the type of procedure, the number of procedures being performed concurrently, the level of proficiency and the year of training. With the exception of radical vulvectomy or pelvic exenteration, two fellows do not scrub together on the same case. The program director determines who scrubs on what case in the event of a schedule conflict. The program director also monitors the surgical case list of the fellows at quarterly intervals to insure that both clinical fellows are accruing the appropriate surgical experience. An attending surgeon is present for all surgical procedures.

Types of procedures that a fellow is expected to learn include simple and radical versions of abdominal hysterectomy and staging procedures, laparoscopic hysterectomy and staging procedures, robotic hysterectomy and staging procedures; radical vulvectomy, sentinel node mapping; bowel resection and anastamosis, urinary conduits and urologic repairs; pelvic exenteration and reconstruction; fertility conserving surgery; and ability to manage surgical complications. Fellows will also become proficient in the administration of chemotherapy and radiation therapy.

In addition to major surgical cases, minor surgical cases such as cervical conization, biopsies, examination under anesthesia, cystoscopy, proctoscopy, laser ablation, and vascular port insertion are done on an out-patient basis or as part of a 23 hour admission procedure. All procedures are under the supervision of the attending faculty.

Conference Schedule
Every other Wednesday afternoon has been dedicated to fellow didactics. On the first and third and fifth Wednesday of each month, the multidisciplinary gynecologic tumor board is held. This time is allocated on the second Wednesday of each month to the division administrative meeting for assessing and planning division activities.

The multidisciplinary gynecologic tumor board is held with the Department of Radiation Oncology and the Division of Surgical Pathology. All patients with newly diagnosed gynecologic cancer who require formulation of a treatment plan, as well as patients who require a new treatment strategy because of a change in disease status are discussed and the pathology is reviewed. The fellows either present the cases or supervise resident presentations and review any radiographic studies of interest. Following review of the pertinent pathology, the fellow discusses management options. After a discussion led by the attending faculty, a plan of management is formalized and recommendation for treatment is established. Formal conference notes are dictated and copies distributed to Medical Records, the UMMC Cancer Registry, and the patient’s attending physician. The fellow dictates these notes which are then reviewed by an attending prior to signature and distribution.
A departmental Morbidity and Mortality (M&M) conference is held every Monday. A list of all patients admitted to the gynecologic oncology service during the preceding week is prepared by the senior resident assigned to the service. Cases of interest and those with complications are presented by the senior resident to the conference participants that include departmental faculty, residents and fellows. The gynecologic oncology fellows assist the residents in the preparation of the weekly case list. The gynecologic oncology fellows participate in discussion and answer questions on complex cases. Gynecologic oncology faculty also participate in this conference and offer pertinent teaching points.

The Fellow Didactic Program is held every other Wednesday afternoon from 5:00 to 6:30 PM. Reading material on a clinical or basic science topic is assigned to each fellow and is discussed by one of the attending faculty. Particular attention is given to areas of controversy and new research. Since 1998, a biannual annual review of surgical anatomy utilizing four consecutive teaching conferences has been carried out including dissection of a cadaver. A live porcine model surgical lab is conducted biannually to augment surgical instruction in operative laparoscopy and management of surgical complications such as vascular and ureteral injury.

Clinical Research
Clinical research activities include institutional studies, industry-funded projects, and participation with two national collaborative groups. The Division of Gynecologic Oncology is an affiliate member of the Gynecologic Oncology Group (GOG). The division enrolls patients in both GOG and SWOG protocols. An important ancillary goal of the two years of clinical training is to provide a framework in which the fellow can learn to balance the demands of clinical care with those of scholarly pursuits, including ongoing laboratory research and manuscript preparation.

Off-Service Rotations and Electives
All gynecologic oncology fellows at the University of Michigan have participated in off-service rotations since the development of the program by George W. Morley, MD, over 30 years ago. Our philosophy has been that fellows benefit by wide exposure to complimentary clinical disciplines relevant to the practice of gynecologic oncology. Off-service rotation electives include urology, general surgery, and breast surgery with options for plastic surgery and vascular surgery rotations. Each fellow will obtain Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS) before completion of the program.

Fellows are not recalled to the gynecologic oncology service when on an off-service rotation unless a rare radical procedure such as a pelvic exenteration is to be performed. This minimizes disruption to both services and permits the fellow to take on a greater level of responsibility on the off-service rotation.

Teaching by Fellows
Fellows are expected to participate in the education of residents and medical students. Two or three residents at different levels of training, one or more medical students, and one pharmacy student are usually assigned to the division for each rotation. The rotations are one month in duration for the residents and pharmacy students, and one to two weeks in duration for the medical students. Residents and medical students function as important members of the health care team under the direction of the gynecologic oncology fellows. This relationship exists in the ambulatory patient clinics, the inpatient service, and the operating room. In addition to teaching on daily work rounds and in the operating room, fellows are asked to prepare and deliver formal lectures and seminars for the resident core curriculum and to lead discussion at department journal clubs.

After Training
Graduates of this program are well trained clinicians. About 75% of the program graduates have entered academic practice. Many graduates have contributed significant advances to the discipline of gynecologic oncology by virtue of their research. Graduates of this program have also been leaders on a national scale, including Presidency of both the Society of Gynecologic Oncologists (SGO) and the American College of Obstetricians and Gynecologists (ACOG), Council of the SGO, Vice Presidency of the SGO, and numerous department chairs and division directors. Graduates of the University of Michigan become members of the George W. Morley Society.