The fellowship in the Division of Gynecologic Oncology at the University of Alabama at Birmingham (UAB) is structured to prepare each fellow for a career in academics. The fellowship selection process identifies candidates with clinical and surgical ability, as well as interest in basic, translational, and/or clinical research. These candidates are given the highest priority for acceptance into the program. The fellowship, approved by ACGME as a 3-year program, consists of 12 months of protected research experience and 24 months of clinical experience. Two fellows are approved for the program each year. All fellows complete their required research at the beginning of the fellowship. Upon completion of the fellowship, the newly trained gynecologic oncologist should have the necessary skills to evaluate and manage patients with a variety of malignant and complex gynecologic conditions, perform advanced open and minimally invasive surgical procedures, and participate in departmental education and research activities.

Introduction

The Division of Gynecologic Oncology is under the leadership of Charles A, Leath, III, MD, MSPH. The Division is an integral part of the O’Neal Comprehensive Cancer Center at UAB, one of 49 NCI-designated centers in the United States. Since its establishment in 1972, the O’Neal Comprehensive Cancer Center has experienced a steady increase in faculty members, research programs, funding and space. The O’Neal Comprehensive Cancer Center currently receives over $110 million in extramural support and has a research space of over 150,000 square feet.

Members of the Division of Gynecologic Oncology enjoy a close relationship with the O’Neal Comprehensive Cancer Center and have appointments to the center as scientists. The division has seven gynecologic oncology faculty and a very large clinical volume promoting the development of skills necessary to demonstrate excellence in all aspects of management of patients with gynecologic cancer. Over the past 30 years, the division has enjoyed significant growth in its faculty, research portfolio, and clinical volume. This expansion has provided an opportunity to restructure the fellowship training program, particularly in areas that will fully prepare fellows graduating from the program to become future leading clinician scientists.

Goals and Objectives

The overall goal of the fellowship is to train fellows as academic gynecologic oncologists who are highly skilled, knowledgeable surgeons capable of contributing to and advancing the field of gynecologic oncology. The objectives of the curriculum are designed to provide each fellow with opportunities to develop proficiency in the following skills:

  • The skill to perform both radical and conservative surgical procedures and the knowledge necessary to determine the most appropriate therapeutic regimen.
  • The knowledge of pathology and physiology to surgically and medically manage women with gynecologic malignancies.
  • The ability to effectively integrate the principles, applications, and risks of the surgical, radiation, and medical therapeutic modalities into a treatment plan appropriate for each patient.
  • The research skills to design and execute innovative laboratory and clinical investigation strategies based upon principles of sound scientific methodology, accurate data analysis, and effective communication of results.
  • Excellent clinical skills involving multidisciplinary cancer care based on biological principles as well as research methodology.
  • Outstanding leadership qualities and effective interpersonal, communication, educational, and management skills.

Research Experience

One of the primary goals of the fellowship is to promote an advanced scientific thought process regarding gynecologic oncology research. This is currently accomplished by a multidimensional approach designed to enhance the fellow’s knowledge base specifically in basic science, translational, and clinical research. This approach currently takes advantage of multiple resources within the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and O’Neal Comprehensive Cancer Center.

During the first year, fellows are positioned within one of several laboratories involved in the Division’s translational research projects. The first-year fellow has protected time to conduct research in an established basic science laboratory on campus. The first-year fellow is assigned to a lab with appropriate working laboratory space and a technical support team. In this environment, the fellow advances a hypothesis-driven basic research project relevant to ongoing gynecologic oncology research.

The fellow participates in a weekly research meeting attended by the scientists involved in their specific area of research. This meeting, as well as other seminars held within the O’Neal Comprehensive Cancer Center, gives the fellow the opportunity to enhance his/her knowledge of important cancer-relevant scientific issues and the conduct of basic science research. This process assists the fellow in developing scientific presentation skills, and allows mentors an opportunity to provide constructive criticism, helping the fellow address any encountered obstacles.

The fellow is expected to keep meticulous records of his/her research projects, as is customarily done by all pre- and post-doctoral trainees. Working under the direct supervision of mentors, the fellow is guided through all aspects of their research project, analysis of the data, production of an abstract and a manuscript with clear anticipation that his/her findings will be both presented at a national scientific meeting and published in a peer-reviewed journal.

Emphasis in the second and third years of fellowship training is in the area of clinical research. The Division of Gynecologic Oncology has a diverse portfolio of NIH, cooperative group, and industry clinical protocols. Generally, these trials focus on important initiatives enhancing our understanding of the biology of female reproductive tract cancers and devising more effective treatment of these cancers. Second- and third-year fellows have extensive exposure to many of these clinical research initiatives within their daily service duties.

In addition, second- and third-year fellows identify various projects of interest and are guided by faculty through the design, implementation, data collection and analysis, and abstract/publication preparation of each project. Fellows meet regularly with the Fellowship Director to review overall progress and research status. In addition, fellows are encouraged to present their research at a national scientific meeting.

In summary, currently available research activities provide fellows with a diverse training in research methods as it relates to gynecologic oncology. The effectiveness of these activities can be measured by the acceptance of fellow-generated abstracts at annual meetings of leading scientific organizations including SGO, ASCO, AACR, ASCCP, and ACOG, by the inclusion of fellow-generated publications in peer-reviewed journals, and by the advancement of fellows into faculty positions that support clinical and translational research in gynecologic oncology.

Clinical Experience

Gynecologic oncology services occur at the University of Alabama Hospital. Patients are hospitalized in the Women & Infant’s Center within a 30-bed unit dedicated to gynecologic oncology and gynecology care. Two of the clinical gynecologic oncology fellows are responsible for this busy service. Four residents are assigned to this rotation. A third clinical fellow is assigned to the Clinic rotation and focuses his/her work on ancillary educational activities including faculty clinics, chemotherapy, radiation, palliative care, and research projects. Fellows rotate on a monthly basis. Clinical fellows round daily with the residents and supervise the preoperative workup and postoperative care performed by the residents. Faculty round daily with the fellows and residents. All hospital admissions, emergency room consults, and hospital consults are initially seen by the residents. The fellow and resident teams are responsible for the initial workup and evaluation of these patients. Lines of supervision are clearly defined for the fellows and residents. Faculty, fellows, and residents attend a “sit-down” conference to discuss all patients currently admitted as part of a dedicated patient “hand off.” Complicated and/or problem patients are discussed in detail and patient care decisions are made at this time. The workload for the following day and the OR schedule are discussed and coverage assignments made by the residents and fellows.

One fellow takes night and weekend call with a faculty member. They are responsible for the gynecologic oncology services and have opportunities for independent thought and management backed by the immediate availability of the faculty. Fellows are provided ample office space, secretarial support, and computer access. Duty hour policies are well established, followed, and closely monitored for the fellows. In compliance with the University Hospital’s duty hour policies, work hours are audited and reported to the Graduate Medical Education office.

Patients are seen in the clinical offices at The Women & Infant’s Center. This facility is located on the UAB campus in the heart of the Medical District in downtown Birmingham. All new patients are evaluated initially by the resident and then presented to the faculty. All gynecologic oncology patients are seen at this facility and the fellow also has his/her Fellow’s Clinic on Thursday afternoon. Patients requiring surgery are scheduled for surgery with the supervising faculty. The fellow independently manages these patients surgically and postoperatively. Fellows also have the opportunity to see patients and operate with faculty at North Mississippi Medical Center in Tupelo, Mississippi.

The Gynecologic Oncology Chemotherapy Infusion Center is also located in the Women & Infant’s Center. Four chemotherapy infusion treatment suites are located in this facility. The fellow is responsible for treatment decisions regarding his/her chemotherapy patients. The research nursing staff and support personnel are also located at the Women & Infant’s Center. Institutional and cooperative trials are actively presented to patients. This team of research nurses monitors research protocols. Research protocols are available to all potentially eligible patients.

In addition to the outpatient clinics, a weekly Colposcopy Clinic is held on Friday mornings. This large referral clinic provides colposcopy and therapeutic services to patients within the state. The clinic is staffed and supervised by the first-year fellow. The fellow performs and/or supervises LEEP procedures and performs colposcopic evaluations. Residents and students from the gynecologic oncology service attend this clinic.

Educational Experience

Each Tuesday morning, fellows and faculty share responsibility for a Resident Teaching Conference where selected gynecologic oncology topics are discussed. Surgical start times are delayed protecting this educational format so that all fellows, residents, and students may attend. Fellows present topics in detail to the gynecologic oncology service during the conference. The purpose of this presentation is to give the fellow an opportunity to critically review the literature on a particular subject, provide a relevant and concise presentation, and field questions from the faculty.

Each Monday afternoon, the Gynecologic Oncology Tumor Board convenes. This multidisciplinary conference is attended by gynecologic oncology faculty, fellows, radiation oncologists, radiologists, residents, and students. All pathology specimens are presented by the Department of Pathology in a PowerPoint format.

Monthly, the fellows and faculty meet for Fellow’s Journal Club. This journal club is designed to review landmark articles and studies. The purpose is to provide a comprehensive review of each disease site. The intent is to provide the fellows with all relevant data to assist with patient management and later can be used for board preparation. Each Friday, fellows participate in a didactic conference, and one or more of the faculty lead this discussion and topics are covered over a two-year curriculum. Members of the gynecologic oncology division actively participate in all department-wide conferences. Each Friday, fellows attend Morbidity and Mortality Conference and other departmental conferences.

Applicant Selection Process

Applicants must register with ERAS for consideration as an applicant to the UAB Gynecologic Oncology Fellowship Program. The basic criteria for downloading an applicant file consist of the following items:

  1. Three letters of recommendation
  2. Personal statement
  3. CV

Invitations are sent to applicants via email with dates available for interviews. The applicants meet with the fellowship director, faculty members, and fellows. We encourage the applicant to come early enough the evening before the interview for a dinner with the current fellows. This social event also serves as an excellent venue for the applicants to meet one another.

For more information contact:

J. Michael Straughn, Jr., M.D.
Gynecologic Oncology
Fellowship Director

Tanya Hallerman
Gynecologic Oncology
Fellowship Coordinator
tbmartin@uabmc.edu
Phone: 205-934-4986
Fax: 205-975-6174