Trends in Fellowship Training for Female Pelvic Medicine and Reconstructive Surgery

Lake, AeuMuro G.; Rickey, Leslie

doi:10.1097/spv.0000000000000406

Cited by 5 publications

(7 citation statements)

References 10 publications

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“…In addition, access to more comprehensive procedure data is limited and is proprietary to the ACGME. However, strengths of this study include a high response rate and consistent findings with another survey study 6 conducted 5 years ago indicating that these patterns have persisted.…”

Section: Discussionsupporting

confidence: 71%

“…For those programs who would accept either urology-trained or gynecology-trained applicants but have received insufficient applications, there may need to be an increase in flexibility regarding training length and advertising strategies. In a study by Lake and Rickey, 6 60% of surveyed FPMRS fellowship programs would require a 3-year fellowship regardless of residency training and 93% would have the same rotation schedule. This is a similar finding to our study cohort.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, 46-61% of FPMRS programs reported acceptance of applicants from either specialty, yet in 1 study, only a quarter of programs had graduates from both residency backgrounds. 3,6 There is a paucity of research evaluating the differences between the 2 different fellowship tracks. Our primary aim is to characterize the differences between UF and GF.…”

mentioning

confidence: 99%

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Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates

Gerjevic¹,

Brandes

Gormley

et al. 2022

Female Pelvic Med Reconstr Surg

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Importance: Understanding differences in female pelvic medicine and reconstructive surgery (FPMRS) urology and gynecology-based fellowships is important because both are accredited by the American Board of Medical Subspecialties. Objective:The aim of the study was to characterize urology-based and gynecology-based FPMRS fellowships.Material and Methods: An institutional review board-approved 21-item survey was emailed to Accreditation Council for Graduate Medical Educationaccredited FPMRS fellowship program directors from January 8 through March 9, 2021. The survey aimed to characterize fellowships through a series of common and specialty-specific questions. Responses were collected with Qualtrics and analyzed using STATA/MP Version 16.1. Results:The response rate was 75% (52/69). Many programs accept both gynecology-and urology-trained applicants (urology-based fellowships, 45.4%; gynecology-based fellowships, 68.3%) since the Accreditation Council for Graduate Medical Education accreditation in 2012. Within the gynecologybased cohort, there have been 10 urology-trained graduates among 7 programs (n = 1-2). Barriers to accepting urology applicants were limited gynecologic knowledge/experience (n = 14) and length of training (n = 11). Thirty-seven (94.8%) reported their graduates log more than 30 hysterectomies and 8.3% (n = 3) log 3 or more urinary diversions.Within the urology-based cohort, there have been 16 gynecologytrained graduates among 4 programs (n = 2-7). Lack of urologic clinical knowledge (n = 4) and training length (n = 2) were cited as barriers to accepting gynecology-trained applicants. Three (27%) reported that their graduates log more than 30 hysterectomies, while 8 (72.7%) reported that graduates log 3 or more urinary diversions.Conclusions: Despite many FPMRS programs stating that they accept gynecology or urology-trained applicants, few fellows graduate from outside specialty FPMRS training programs. Several barriers were identified that may prevent trainees acceptance outside of their residency specialty. Procedural training experience differs between urology-and gynecologybased fellowships.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates

Gerjevic¹,

Brandes

Gormley

et al. 2022

Female Pelvic Med Reconstr Surg

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“…This is most likely related to fellowship training and that the majority of female pelvic medicine and reconstructive surgery subspecialists are from a gynecology background, and the majority of urologists and "other" specialists in this cohort did not undergo extended training for performing these procedures. 23 The strongest predictors of GUTI in this study were intraoperative surgical factors, including lysis of adhesions, hematoma, and blood transfusion. These factors may reflect an increased difficulty of the surgical case, for example, the alteration of normal anatomy due to prior surgery or conditions such as endometriosis requiring complex dissection, and have also been associated with other intraoperative complications at the time of hysterectomy such as bowel injury.…”

Section: Discussionmentioning

confidence: 61%

“…In addition, we found that surgical procedures performed by nongynecologic surgeons, urologists, and “other” specialties were significantly more likely to be associated with GUTI. This is most likely related to fellowship training and that the majority of female pelvic medicine and reconstructive surgery subspecialists are from a gynecology background, and the majority of urologists and “other” specialists in this cohort did not undergo extended training for performing these procedures 23 …”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Sheyn¹,

Gupta

Boyd

et al. 2022

UROGC

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Importance The rate of genitourinary tract injury (GUTI) following pelvic organ prolapse (POP) surgery is presently ill-defined and based on relatively small trials with short follow-up time. Given the potential for higher risk of injury with POP, a better understanding of this type of injury is important for patient counseling. Objectives The objective of this study was to identify the incidence and risk factors of GUTI related to POP surgery. Study Design Women undergoing POP surgery between 2010 and 2019 were identified using Current Procedural Terminology codes in the Premier Healthcare Database. The primary outcome was GUTI, defined as bladder or ureteral injury, and vesicovaginal or ureterovaginal fistula within 1 year of surgery. Genitourinary tract injury was identified using International Classification of Diseases and Current Procedural Terminology codes. Patients were divided into those with and without GUTI. Differences between groups were evaluated using the Student t test, Wilcoxon rank-sum test, and Fisher exact test as appropriate. Multivariable logistic regression was used to evaluate the independent predictors of GUTI. Results One hundred thirty-nine thousand one hundred fifty-eight surgical procedures for POP were captured between 2010 and 2019. The rate of GUTI was 1.10%: 0.48% bladder, 0.64% ureteral injuries, and 0.01% fistulas. The most significant variables associated with any GUTI were as follows: adhesiolysis (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.07–6.51), blood transfusion (aOR, 3.67; 95% CI, 1.34–10.04), and low-volume surgeons (<12 cases per year) (aOR, 1.68; 95% CI, 1.60–1.77), nonurologic or gynecologic surgeon specialty (aOR, 1.62; 95% CI, 1.49–2.00), and uterosacral suspension (aOR, 1.30; 95% CI, 1.13–1.49). Conclusions The rate of GUTI following POP surgery is lower than has previously been reported. Surgeon experience and specialty and surgical approach may affect GUTI incidence.

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Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency

Wang

Smith

et al. 2023

Neurourology and Urodynamics

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IntroductionContemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown.MethodsAccredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology‐based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross‐check of program and faculty training characteristics was performed through direct communication with 5% of programs.ResultsOf 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology‐based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty‐to‐resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, faculty‐to‐resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health. The FPMRS faculty‐to‐resident ratio was 1:5.1 in programs with a urology‐based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship.Conclusions30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.

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Trends in Fellowship Training for Female Pelvic Medicine and Reconstructive Surgery

Abstract: There are several FPMRS fellowship models. A significant proportion of PDs would like a more integrated fellowship program, and an overwhelming majority note benefits for themselves and their fellows that result from increased contact with a diverse FPMRS faculty.

Cited by 5 publications

References 10 publications

Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates

Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency

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