The three-year fellowship training program in Gynecologic Oncology at Washington University School of Medicine is under the auspices of the Division of Gynecologic Oncology, within the Department of Obstetrics and Gynecology. It is currently coordinated by Dr. Matthew A. Powell. The clinical facilities for the Department of Obstetrics and Gynecology include the primary facility of Barnes-Jewish Hospital, the major hospital facility of the Washington University School of Medicine. The Washington University Medical Center is a major tertiary care center and receives referrals from all parts of Missouri, southern Illinois and other neighboring mid-western states.

PROGRAM:
The initial year of fellowship will consist of basic laboratory research directed by one of the many full-time research faculty associated with the Department of Obstetrics and Gynecology.

The subsequent two years will be spent in clinical gynecologic oncology, under the guidance of four full-time faculty members who have appointments at the Washington University School of Medicine. Each full-time faculty member rotates as attending for the Gynecologic Oncology Team. The team consists of the two fellows, one fourth-year resident, two third-year residents, one second-year resident and one first-year resident. Each faculty member is always ready to assist the fellow in obtaining the knowledge, skill and capability to manage all gynecologic oncology patients.

The fellow will also interrelate with the Divisions of Radiation Oncology (Mallinckrodt Institute of Radiology) and Medical Oncology.

It is expected that the fellow will acquire the following tools of the trade:

• Understanding, skill and capability to perform radical pelvic surgery independently
• Manage intestinal, urologic and vascular problems caused by gynecologic malignancies or their treatments
• Handle non-operative management of associated conditions and disorders of the intestinal and urinary tract
• Participate as a member of the a team which plans and applies all forms of radiotherapy
• Be able to select patients, choose appropriate drugs, administer therapy and care for the toxic side effects of chemotherapy

The trainee is expected to take a graduate level course in biostatistics through the medical school, as well as one other graduate level course such as molecular biology. These courses are taken during the first, non-clinical year. The trainee is also expected to attend a number of weekly seminars, conferences and lectures, given within the department, as well as the medical center. The fellow will be encouraged to attend regional or national scientific meetings which are pertinent to the field of gynecologic oncology, and funding is available for such meetings. Presentations at such meetings are strongly encouraged as well.

The gynecologic oncology fellow will also be responsible for giving several formal lectures within the department, as well as other departments. Student lectures will also be the responsibility of the fellow as scheduled. The second year clinical fellow is responsible for the weekly Tumor Conference, held jointly with the Division of Radiation Oncology and the Department of Pathology. The first year clinical fellow is responsible for the weekly Cervical Correlations Conference and the non-clinical fellow is responsible for the monthly journal club.

The division actively participates in intramural clinical studies, industry-sponsored studies as well as national cooperative groups such as the Gynecologic Oncology Group and the Radiation Therapy Oncology Group.

CLINICAL GYNECOLOGIC ONCOLOGY ROTATION:
The fellow’s weekly service rotations include surgeries related to gynecologic malignancies, with intracavitary implantation of radioactive sources. The fellow must participate in all surgical procedures in the categories defined by the American Board of Obstetrics and Gynecology (surgeon, co-surgeon, assistant), depending upon the type of surgery being performed, the level of the fellow’s proficiency and the year of training. Periodic meetings with the program director will assure the fellow’s active participation in the training program.

One day a week is reserved for ambulatory service patients, many of whom will be pre-operative, post-operative, undergoing current therapy or follow-up patients. Over 450 new gynecologic cancer patients are seen in the medical center each year. One afternoon a week is reserved for Colposcopy Clinic and approximately 15-20 patients are scheduled each week, with referrals coming from within the institution as well as outside.

OFF-SERVICE ROTATIONS:
Gynecologic oncologists within the Division have managed and performed intestinal and urologic surgery related to gynecologic malignancies for well over twenty-five years. However, in order to provide the fellow with a concentrated experience in the care of seriously ill patients, a four-week rotation in the Surgical intensive Care Unit was established. The rotation is under the supervision of the Departments of Surgery and Anesthesia. All aspects of critical patient care including respiratory, cardiovascular, hemodynamics, electrolyte and fluid balance are taught by direct bedside teaching.

There is a long established tradition of cooperation between the Division of Gynecologic Oncology and the Division of Radiation Oncology. All intracavitary implants are performed jointly by the radiation oncologist and the gynecologic oncologist. There is a joint weekly conference and there is a four-week rotation on the radiation therapy service. In addition, the fellows are required to attend didactic lectures in radiation physics and radiation biology given by the Division of Radiation Oncology during this rotation.

PROGRESSIVE RESPONSIBILITY:
The ultimate goal of the Division of Gynecologic Oncology is to train physicians who are capable of functioning as independent gynecologic oncologists. That is why all aspects of patient management are equally emphasized.

In order to achieve this goal, fellows are given progressive clinical responsibilities during the two years of clinical training. Since it is recognized that different fellows may possess different backgrounds, knowledge, skill and learning ability, this progression in responsibility cannot be set by a fixed schedule. It can only be accomplished by ongoing evaluations on an individual basis. Through daily contact, close interactions and direct supervision by faculty members, each fellow is evaluated for his or her initiative, knowledge, competency and skills in the operating room, at the bedside and in the ambulatory care clinics. Appropriate responsibilities are then given the fellow and increased in proportion to the fellow’s progress. The amount of clinical material and total commitment of faculty members assure the maturity of our fellows in their clinical years.