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Obstetrics & Gynecology - Minimally Invasive Surgery

At A Glance

Program Type: Military Medical Center

Location: Bethesda, MD

Accredited: Yes, American Association of Gynecologic Laparoscopists (AAGL)

Program Length: 2 years

Required Pre-Requisite Training: Medical School Graduation, Completion of Obstetrics and Gynecology Residency

Categorical Year in Specialty Required: No

Total Approved Complement: 2

Approved per Year (if applicable): 1

Dedicated Research Year Offered: No

Medical Student Rotation Availability: No

Additional Degree Concurrent with Training (e.g. MPH): No

Program Description

The National Capital Consortium (NCC) Minimally Invasive Gynecologic Surgery (MIGS) Fellowship, developed in 2009, as a joint program between the NCC and Holy Cross Hospital. The NCC consists of a collaborative agreement between Walter Reed National Military Medical Center (WRNMMC), Malcolm Grow Medical Clinics and Surgery Center (MGMCSC), A.T. Augusta Military Medical Center (ATAMMC), and The Uniformed Services University of the Health Sciences (USUHS) for the purpose of GME training. The NCC is located in the national capital area and takes advantage of the large diverse patient population and a tri-service, worldwide referral base. The NCC MIGS program is co-located with the NCC Gynecologic Oncology Fellowship, NCC Fellowship in Urogynecology and Pelvic Reconstructive Surgery and the National Institutes of Health (NIH) Fellowship in Reproductive Endocrinology and Infertility.

In 2022 our partnership with Holy Cross Hospital ended. As result NCC MIGS program looked to form a strategic partnership and collaboration with Inova Hospital System (IHS). The driving factors for the NCC – IHS partnership included enhanced surgical experience (increased surgical numbers and variety of procedures), increased number of participating MIGS faculty (greater breadth of experience) and increased national recognition of participating faculty devoted to mentoring fellows. Our program is specifically structured with emphasis on exploiting the strengths and resources of each institution.

The MIGS Section is in the Division of General Gynecology located within the Department of Gynecologic Surgery and Obstetrics (GS&O) at WRNMMC, a world-renowned institution that has been designated a Military Center of Excellence. As such, WRNMMC receives patient referrals for treatment of complex gynecological patients from not only the local area, but also the entire eastern United States and Europe. The OB/GYN Department at WRNMMC provides the clinical space for the MIGS Section to evaluate and treat patients, as well as, administrative support and administrative office space for the fellows and faculty.

USUHS is the medical school affiliated with all NCC approved training programs. The GME Committee provides funding, administrative and legal support for the fellowship, for activities such as the application of the fellowship with AAGL, Memoranda of Understanding with other training facilities, and faculty development for the Program Directors and all departmental faculty. USUHS and its’ OB / GYN Department, also, provide the academic appointments appropriate for the level of academic experience for the faculty and the Clinical Instructor appointment for the fellows. In addition, the faculty and fellows provide lectures and/or career counseling sessions for the medical students and residents.

The second clinical site for the MIGS Fellowship is located at IHS in Alexandria, VA. WRNMMC and IHS are located approximately 30 minutes from each other. The clinical practice consists of an excellent variety of patient’s requiring advanced laparoscopic and robotic-assisted laparoscopic approaches to complex gynecological problems.

Specifically, the NCC-MIGS fellowship consists of two years of clinical training that is divided between WRNMMC and IHS. Both institutions have strong academic backgrounds and large clinical populations with requirements for minimally invasive gynecologic surgery. Research will focus on clinical research primarily at WRNMMC, with contributions from IHS as opportunities arise, and possibly, basic science research as applied to minimally invasive gynecologic surgery in the basic science divisions of OB/GYN at USUHS or the NIH.

Mission, Vision and Aims

Mission

The comprehensive goal of the NCC Fellowship in Minimally Invasive Surgery is to train academic fellows who are outstanding clinicians, teachers, and research contributors. The clinical educational objective of the training program is to provide fellows with the necessary knowledge, skills and experience to independently manage complex gynecologic patients that may benefit from advanced endoscopic procedures.

Vision

The vision of the fellowship program is to train highly skilled military physicians in minimally invasive surgery who will:

Improve the quality of care for women.
Expand the knowledge in the field through basic science and clinical research.
Develop into scholarly educators and leaders in Minimally Invasive Gynecologic Surgery.

Curriculum and Schedules

Didactic content is offered weekly.

Fellows spend 50% time at WRNMMC and 50% time at Inova Health System in Alexandria, Virginia.

There are currently no electives are offered in our program.

Fellows spend one shift per month while rotating at WRNMMC.

Online training is provided. Fellows also have the option to participate in residency military unique curriculum including officer development as needed.

Stanford – Biomedical Statistics Course (Completed virtually during first year)

Listed below are all the required simulation events for the fellows. Items denoted with (*) indicated workshops with residents where they will have the opportunity to perform the simulation as well as act as surgical educators for residents

DHA Multispecialty Robotic Training Curriculum

Introduced in 2023 with plans for implementation in starting July 2023 will include the following:

Intuitive Learning – Online robotic training
Operative Workshops at Uniformed Service University Robotics Lab (Docking, instrument exchange, console time)
Bedside assisting (10 cases)
Completions of Intuitive Surgical SimNow Modules
- Score >90% on 6 milestone modules

OB/GYN Residency Quarterly Simulation Curriculum*

Thursday afternoons, organized by Dr. Thuan Le, MIGS Core Faculty and Residency Simulation Coordinator

GYN Simulation Exercises

SimSei Applied Medical Laparoscopic Training System
- Port Placement
- Basic and complex laparoscopic skills training (peg board, hysterectomy)
- Hand-eye coordination, Dexterity, Depth perception
Laparoscopic myomectomy
Tissues Extraction with cow tongue model
Anterior and Posterior Repairs
Mid-Urethral Slings
Hysteroscopic resectoscope

FMIGS Annual Bootcamp

Fellows will attend the Annual FMIGS bootcamp held concurrently with the AAGL Global Congress. This is a one day even where fellows will participate in didactic and simulation activities including the following:

Vaginal Natural Orifice Endoscopic Surgery (vNOTES)
DaVinici Surgical Training – Simulation, Port Placement
Laparoscopic Training – Port Placement, Vaginal cuff closure, suturing

Hysteroscopic Simulation

Diagnostic and Hysteroscopic morcellators

Scholarly and Professional Development Opportunities

During training, the fellow will undertake an independent original research project approved by the fellowship director. The research experience will be initiated in the first year of fellowship training. A research mentor who has expertise (i.e. proven track record of hypothesis-based research publications) in clinical research and is available and regularly meets with and mentors the fellow will be appointed. Under the supervision of the research mentor, the fellow must complete, by the end of his/her final academic year, at least one Institutional Review Board (IRB) approved (if applicable) research project relevant to minimally invasive gynecologic surgery. This research project must be an original data-driven project, meta-analysis or a systematic review that conforms to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and ultimately must be submitted for publication to a peer-reviewed journal by the end of fellowship. Writing a textbook chapter, clinical opinion review article, or production of an educational/scientific video does not meet criteria for an approved research project. It is the expectation that the fellow thesis will result in publication.

Participating Sites

Inova Hospital System - Alexandria

Applicant Information, Rotation and Interview Opportunities

We do not offer resident rotation opportunities during the fellowship interview season from outside hospitals to be fair to inclusivity and equity as other applicants may not have the funds or opportunities to rotate with us and this may confer an unfair advantage to that candidate.

With that said, for interested medical students, we offer a 1-week rotation as part of the 3rd year USUHS Obstetrics and Gynecology core clinical rotation block. For interested 4th year medical students we offer a 2-week rotation through the Department of Obstetrics and Gynecology for USUHS and HPSP students interviewing for a military Obstetrics and Gynecology Residency.

Candidates will undergo virtual interviews with PD and APDs during pre-defined window.

No board certification is offered.

Teaching Opportunities

The NCC Uniformed Services Residency in Gynecologic Surgery and Obstetrics (GS&O) is recognized as one of the premier residency programs in the United States. Minimally Invasive Gynecologic Surgery (MIGS) Fellows play an integral role in the education of residents and medical students within the department. A third year resident and one or more medical students are assigned to the division for each rotation. Residents and medical students function as important members of the health care team under the direction of the MIGS fellows.

Fellows are expected to serve as supervisor, teacher, role model, and assessor and as such are expected to promote student and resident education in a positive and thorough manner.

Fellow as a Role Model:

Role modeling behavior includes ethical behavior and professionalism, medical reasoning, clinical decision-making, and compassionate, humanistic approaches to patient care.
Residents and Medical Students should be treated with respect. Destructive, belittling comments do not enhance learning and are inappropriate.
Fellows will be asked to prepare 1 to 2 didactic lectures for the Department of GS&O each year and present at least 1 grand rounds during the year of the fellowship.
Each fellow will also be asked to attend, present, and lead discussions at quarterly MIGS Journal Club.