Gynecology

  • Curriculum

    Approximately 60 percent of fellowship activities involve clinical care, divided between OR, ambulatory and inpatient services. Fellows will be supervised by experienced pediatric / adolescent gynecologists with gradually increasing independent clinical responsibilities during clinical sessions. Although residency-trained and board-eligible ob / gyn physicians, the fellows will not practice independently for any clinical care at Cincinnati Children's. Their activities will be closely supervised by the faculty fellowship director and other faculty gynecologists in a graduated fashion. Complex clinical cases, including surgeries for complex genital anomalies, will require supervision and direct oversight by faculty physicians. It is expected that fellows in pediatric and adolescent gynecology will supervise resident physicians, medical students and other trainees in our multidisciplinary clinic.

    Approximately 40 percent of the fellowship will involve research and scholarly activities. Research in the Division of Adolescent Medicine focuses on three areas: fertility preservation, the effect of puberty on young women’s reproductive health and adolescents with chronic medical illnesses. The research training program in the Division of Pediatric & Adolescent Gynecology includes the following components: a didactic program focused on patient-oriented clinical research, a mentored research project, a Scholarship Oversight Committee and evaluation procedures. Each fellow in the division is assigned to a Scholarship Oversight Committee comprised of members both inside and outside the fellow’s area of expertise. This committee meets with the fellow twice per year to provide guidance and support and to ensure that fellows are making progress in their research efforts. It is our expectation that the fellow in pediatric and adolescent gynecology will participate in this research mentoring. Other scholarly activities include literature reviews, case reports, clinical presentations and graduate coursework (as desired).
  • Goals, Objectives and Training

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    Goals

    The goals of the fellowship program in pediatric and adolescent gynecology at Cincinnati Children’s Hospital Medical Center are to prepare its graduates to serve as expert clinical consultants in the management of children and adolescents with gynecological problems; educational leaders in the field of pediatric and adolescent gynecology; advocates for the provision of high-quality, accessible gynecological services to all children, adolescents and adult women; and primary or co-investigators in clinical research projects.

    Objectives

    Objectives designed to achieve these goals are to:

    1. Communicate effectively with girls of all ages to establish rapport, obtain a reliable medical history, facilitate adherence to medical recommendations and promote healthy lifestyles.
    2. Communicate effectively with families to encourage adult involvement while respecting individual patient rights to privacy and confidentiality.
    3. Recognize the value of and contribute to an interdisciplinary team approach to adolescent healthcare.
    4. Be aware of the medico-legal aspects of pediatric and adolescent gynecology and be able to cite relevant state laws.
    5. Understand how psychosocial development during adolescence affects gynecological health and healthcare.
    6. Differentiate normal from abnormal sexual development during childhood.
    7. Differentiate normal from abnormal female pubertal development.
    8. Counsel patients and families about pubertal development, menstrual function, sexual health and sexual risk behaviors.
    9. Recognize and manage the childhood antecedents of common adult diseases in females, such as obesity, osteoporosis and polycystic ovary syndrome.
    10. Diagnose and manage common gynecologic problems of childhood (vaginal discharge, vulvar rashes, condyloma, labial adhesions, imperforate hymen).
    11. Evaluate and manage genital trauma.
    12. Screen children and adolescents for sexual, physical and emotional abuse as part of routine gynecologic care and know how to respond if suspected.
    13. Know how to manage patients with physical sequelae of past abuse.
    14. Recognize and screen for depression, suicidal ideation and other mental health problems and know how to respond if detected.
    15. Evaluate an adolescent for abnormalities of pubertal development, including precocious puberty, abnormal bleeding, delayed puberty and primary and secondary amenorrhea.
    16. Evaluate and manage congenital anatomic anomalies (imperforate hymen, vaginal septa, uterine duplications, vaginal agenesis).
    17. Evaluate and manage hyperandrogenism and its sequelae (hirsutism, acne, abnormal bleeding, insulin resistance, obesity, hypertension).
    18. Manage the adolescent with ovarian cysts.
    19. Manage the adolescent with chronic pelvic pain and understand the indications for operative intervention.
    20. Understand the indications for and the performance of laparoscopy in children and adolescents.
    21. Evaluate and manage adolescents with endometriosis.
    22. Independently perform common surgical procedures (diagnostic laparoscopy, surgical ablation of genital warts, ovarian cystectomy, management of ovarian torsion).
    23. Serve as a consultant to other health professionals, demonstrating appropriate written and verbal communication skills.
    24. Guide primary care providers in the care of common menstrual problems during adolescence (primary dysmenorrhea, oligomenorrhea).
    25. Manage or provide consultation regarding the diagnosis and management of early pregnancy and its complications.
    26. Manage or provide consultation regarding the management of abnormal bleeding.
    27. Manage or provide consultation regarding the induction of therapeutic amenorrhea and management of menstrual suppression.
    28. Manage or provide consultation regarding gynecologic problems of individuals with physical and mental disabilities and handicaps.
    29. Manage or provide consultation regarding gynecologic issues for young women with chronic diseases.
    30. Evaluate and manage genital warts, HPV infection, abnormal cervical cytology, including cervical dysplasia in adolescents.
    31. Evaluate, manage and counsel patients with sexually transmitted infections, including pelvic inflammatory disease.
    32. Participate in the management of patients with gynecologic tumors.
    33. Practice in an appropriate and collegial manner as a member of an interdisciplinary team of colleagues.
    34. Become familiar with clinical research methodology and be able to develop hypotheses, design a research study, conduct analyses and write a research manuscript.
    35. Submit at least one abstract to a national meeting and develop a manuscript for publication in a peer-reviewed journal.
    36. Complete at least one review article or chapter for publication.

    Qualifications of Applicants

    It is anticipated that applicants will have successfully completed a residency in obstetrics and gynecology. They will have taken the written examination given by the American Board of Obstetrics and Gynecology, given in June of their last year of residency training.

    Duration of Training

    The duration of the fellowship in pediatric and adolescent gynecology is two years, starting in July and continuing for two academic years. In general, the fellow will be expected to devote 60 percent effort for direct patient care and 40 percent for research and other scholarly activities.

    Number of Trainees per Year

    The number of fellows per year will depend on two factors: clinical volume and applicant strength. Initially, we anticipate only one new fellow per year, with an overlap during the second year.