Resident Experience 

The mission of the Division of Urogynecology and Pelvic Reconstructive Surgery is to provide the whole spectrum of patient treatment options in a multidisciplinary fashion to women with pelvic floor disorders including urinary incontinence, fecal incontinence, pelvic organ prolapse, and other pelvic floor pathology. Through this comprehensive multidisciplinary approach, we hope you find that our teaching mission to residents is enriched.

Two residents (PGY2 and 4) are assigned to the Urogynecology service at any one time. Urogynecology Clinics take place at The Kirklin Clinic as well as at the Women's and Infants Center (WIC). Clinical teaching focuses on doing an in-depth history often involving the use of validated questionnaires in which to further explore patient’s symptoms and impact on quality of life, detailed physical examination, discussion of physical findings with the patient, as well as range of treatment options that may pertain to her (this may involve non-surgical or surgical therapies). Further discussion of expectations, as well as short-and long-term follow ups are also discussed.

Through the course of these clinical evaluations, patients are often evaluated on an objective level with the use of multi-channel urodynamics for those women with urinary incontinence, as well as the use of external surface EMG, anomanometry, and endoanal ultrasound as needed for the objective testing and evaluation of women with fecal incontinence symptoms. Residents and fellows get hands-on training in both the physical evaluation, as well as objective diagnostic techniques. For those patients who go to surgery, residents are typically involved with all aspects of their perioperative care including ascertaining need for preoperative testing and plans for postoperative pain management. The Division of Urogynecology and Pelvic Reconstructive Surgery, as noted above, consists of four full-time urogynecologist faculty and currently has four fellows in an ABOG accredited fellowship in Female Pelvic Medicine and Reconstructive Surgery.

Operative experience is gained by fellows, residents, and medical students on Mondays, Tuesdays, Wednesday, Thursdays, and Fridays at the UAB new North Pavilion operating rooms as well as at the UAB Highlands operating rooms on Mondays. Residents assist or are the primary surgeons with faculty assisting on all cases with a level of participation determined by level of expertise. Patients seen by the faculty and fellows of the Division of Women’s Pelvic Medicine and Reconstructive Surgery are referred from the UAB community, State of Alabama, as well as the entire Southeast, therefore providing experience at all levels of potential operative (both abdominal and vaginal approaches to prolapse and incontinence procedures), as well as non-operative treatment modalities.

Residents and fellows participate in regular didactic sessions through the Division of Women’s Pelvic Medicine and Reconstructive Surgery. Typically on Monday mornings after Dr. Varner’s surgery, he lectures on some aspect of the surgeries or urogynecologic issues that were addressed that day. Every Tuesday morning at 0700 the faculty and fellows rotate regular interactive didactic sessions. On either the first or second Wednesday afternoon of every month, there is a fellow’s conference that the residents and medical students are encouraged to attend, where didactic urogynecologic lecture or journal club ensues or an update and discussion on the current research protocols being conducted through the Division. Furthermore every Thursday morning, Dr. Richter conducts walk rounds with the residents and medical students.

Dr. Richter has a very strong interest in Geriatrics and has received funding in the past for the incorporation of a Geriatric curriculum into Ob/Gyn Residency Program. Dr. Richter partnered with Dr. Alayne Markland, Geriatrician in the Division of Geriatric Medicine and Gerontology, and together they have provided lecture series during the Resident Friday Didactic Conferences.

All residents, whether in the clinical setting performing physical examinations or performing diagnostic testing studies, are with a faculty attending. Typically, the patient findings are discussed in a separate office with interaction of the residents and the attending physician and treatment plans are formed. Any gynecological consults are typically seen by the residents and presented to the faculty and then subsequently seen with faculty. Faculty and/or fellows are present for all surgical interventions performed on Urogynecology patients. Postoperative evaluation and care is also performed in partnership with the faculty, typically with daily rounds including discussions of postoperative treatment plans with potential modifications.

The Division of Urogynecology and Pelvic Reconstructive Surgery is very strong with respect to faculty and fellows interacting with the residents on research projects, which are required of all residents prior to finishing residency. All of the research studies allow the Urogynecology Division to further interact on an even greater level directly with the residents, hopefully stimulating interest in an academic career in urogynecology.