Advertisement

The fellowship effect: how the establishment of a fellowship in female pelvic medicine and reconstructive surgery affected resident vaginal hysterectomy training

      Objective

      We report on trends in resident-performed vaginal hysterectomies before and after the establishment of a female pelvic medicine and reconstructive surgery fellowship at Vanderbilt University Medical Center.

      Study Design

      We examined medical records and resident self-reports concerning all hysterectomies at our institution in an 8-year period: 4 years before fellowship and 4 years after. Route of hysterectomy, resident and fellow involvement, and division of attending surgeon were recorded from the electronic medical record. Resident Accreditation Council for Graduate Medical Education (ACGME) case log data were used to estimate the number of hysterectomies where residents reported themselves as the primary surgeon.

      Results

      During the 8-year period of this study, 3317 hysterectomies were performed at our institution, 41% (1371) before and 59% (1946) after fellowship. Prior to fellowship, 29% (393) were vaginal, 56% (766) were abdominal, and 15% (212) were laparoscopic/robotic. After addition of fellowship, 23% (449) were vaginal, 31% (597) were abdominal, and 46% (900) were laparoscopic/robotic. Of the total vaginal hysterectomies (TVH), there was resident involvement in 98.0% (385) cases before fellowship and 98.2% (441) cases after fellowship. From the ACGME case log data, the resident identified himself/herself as the primary surgeon in 388 cases before and 393 cases after fellowship. During this time period, medical records indicate a fellow was involved in 42% (189) of TVH, with resident involvement in all but 5 of these procedures.

      Conclusion

      Frequency of resident involvement in TVH cases, either as primary surgeon or team member, remained constant after the addition of the female pelvic medicine and reconstructive surgery fellowship.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American College of Obstetrics and Gynecology
        Choosing the route of hysterectomy for benign disease. ACOG Committee opinion no. 444.
        Obstet Gynecol. 2009; 114: 1156-1158
        • Nieboer T.E.
        • Johnson N.
        • Lethaby A.
        Surgical approach to hysterectomy for benign gynecological disease.
        Cochrane Database Syst Rev. 2009; 3: CD003677
        • Garry R.
        • Fountain J.
        • Mason S.
        • et al.
        The eVALuate study: two parallel randomized trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.
        BMJ. 2004; 328: 129-135
        • Oliphant S.S.
        • Jones K.A.
        • Wang L.
        • et al.
        Trends over time with commonly performed obstetric and gynecologic inpatient procedures.
        Obstet Gynecol. 2010; 116: 926-931
        • Turner L.C.
        • Shepherd J.P.
        • Wang L.
        • et al.
        Hysterectomy surgical trends: a more accurate depiction of the last decade?.
        Am J Obstet Gynecol. 2013; 208: 277.e1-277.e7
        • Wright J.
        • Ananth C.
        Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease.
        JAMA. 2013; 309: 689-698
        • Kenton K.
        • Sultana C.
        • Rogers R.G.
        • et al.
        How well are we training residents in female pelvic medicine and reconstructive surgery?.
        Am J Obstet Gynecol. 2008; 198: 567.e1-567.e4
        • Burkett D.
        • Horwitz J.
        • Kennedy V.
        • et al.
        Assessing current trends in resident hysterectomy training.
        Female Pelvic Med Reconstr Surg. 2011; 17: 210-214
      1. Accreditation Council for Graduate Medical Education. National data report: obstetrics and gynecology case logs, 2003-2009. Available at: http://acgme.org/residentdatacollection/documentation/statistical_reports.asp. Accessed May 1, 2013.

        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Occhino J.A.
        • Hannigan T.L.
        • Baggish M.S.
        • et al.
        Their effect on operative experience in obstetrics and gynecology.
        Gynecol Obstet Invest. 2011; 72: 73-78