This two-year clinical fellowship program is intended to provide additional clinical and academic experience in pediatric and adolescent gynecology for individuals who have completed a basic residency program in obstetrics and gynecology and who wish to pursue careers as clinician educators or investigators in academic medical centers. The program is based in the Division of Pediatric and Adolescent Gynecology, Cincinnati Children’s Hospital Medical Center, and is directed by Lesley Breech, M.D. 

The Pediatric and Adolescent Gynecology (PAG) Fellowship Program seeks to create a new model of gynecological care, in which expert gynecologists work side-by-side with a multidisciplinary team of providers to provide comprehensive care for girls with complex reproductive health issues. The PAG program maintains a referral practice of pediatric and adolescent gynecology within the Department of Surgery. Our program maintains an ongoing relationship with the Division of Adolescent Medicine, which also houses the teaching program for pediatric residents, U.C. medical students, and the fellowship in Adolescent Medicine.

Only four obstetrics-gynecology subspecialty fellowships are recognized by the American College of Graduate Medical Education (ACGME) and the American Board of Obstetricians and Gynecologists (ABOG): reproductive endocrinology and infertility; maternal-fetal medicine; gynecologic oncology; and urogynecology/reconstructive pelvic surgery. It is unclear when the subspecialty of pediatric and adolescent gynecology will be recognized as an additional formal area of subspecialization in the near future, given its small area of concentration. However, ABOG has demonstrated interest in the growing discipline. Nevertheless, the subspecialty of pediatric and adolescent gynecology is a viable area of focus within the field. There are approximately 350 members of the professional organization, the North American Society for Pediatric and Adolescent Gynecology (NASPAG), which comprises pediatricians, internists, and family medicine, as well as gynecologists. The Council on Resident Education in Obstetrics and Gynecology lists a number of objectives related to pediatric and adolescent gynecology.

Few medical centers have expert faculty or the established patient population to support clinical training in pediatric and adolescent gynecology. Cincinnati Children's has experienced, full-time, PAG trained gynecological faculty who serve only children and adolescents. As a result, it has drawn national attention for its leadership in NASPAG, the Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists (ACOG), the Adolescent Initiative of the Association for Reproductive Health Professionals, and the Adolescent Reproductive Research Group of the International Clinical Epidemiology Network.

A primary goal of the fellowship program is that graduates will pursue careers as clinician educators or investigators in academic medical centers, and will work to improve health care services and professional training in pediatric and adolescent gynecology.

Approximately 60% 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. Complex clinical cases and all OR cases, including but not limited to 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 clinics.

Approximately 40% of the fellowship will involve research and scholarly activities. Research in the Division of PAG focuses on these areas: fertility preservation; menstrual regulation; development and function of the ovary, including the effect of medical conditions on young women’s reproductive health; and clinical outcomes of surgical treatment of congenital reproductive anomalies. The research training program 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).