Clinical
The goal of our training is to produce highly skilled and knowledgeable clinician-surgeons who are able to care for women with complex pelvic floor disorders. The clinical curriculum reflects a multidisciplinary approach, with FPMRS rotations supplemented by exposure to subspecialty training in pelvic pain, pediatric and adolescent gynecology, colorectal and GI disorders, pelvic floor physical therapy, general urology, and transgender care. The clinical hubs are Kaiser Permanente East Bay and UCSF.
Clinical Hubs for FPMRS
KP East Bay boasts one of the most culturally and socioeconomically diverse patient populations in the United States, and care is provided within a truly integrated system that places high value on efficiency, innovation, consistency of clinical outcomes, and patients’ ease of access to care. While at KP East Bay, you will work with fellowship-trained faculty from Urogynecology, Female Urology, Colorectal Surgery, Chronic Pelvic Pain, and Pediatric/Adolescent Gynecology. Clinical training will enable you to perform simple and multichannel urodynamics, diagnostic and operative cystoscopy, and preoperative evaluation and counseling of patients with pelvic floor disorders amenable to surgical treatment, a variety of surgical approaches to the correction of urinary incontinence and pelvic organ prolapse, evaluation and treatment of fistulas, urethral diverticulae, complex and chronic obstetrical lacerations, and GU anomalies. Importantly, we value a surgeon’s ability to perform both vaginal and abdominal (laparoscopic as well as robotic) pelvic reconstructive surgeries, as we believe this is essential to providing high quality, patient-centered care. Fellows are also trained to perform endo-urologic procedures (retrograde pyelograms and stent placement) and ureteral reimplantation with an opportunity to participate in complex urinary reconstructive procedures, including urinary diversions.
UCSF: At the University of California San Francisco Medical Center, the fellow will be integrated into a tertiary care, academic research institution. The fellow will participate in the care of women captured by the large catchment of UCSF (from north of Los Angeles to the Oregon border and neighboring states) who need evaluation and treatment of complex pelvic floor disorders and surgical complications. We work closely with our colorectal surgery, female urology, and plastic surgery colleagues, especially in repair of complicated fistulae. UCSF is committed to the service of the community and accepts Medicare and Medicaid, allowing us to care for those with otherwise limited access to care. Additionally, fellows have the opportunity to participate in global health experiences. Our division is active in clinical care of fistula patients in Rwanda and has ongoing NIH-funded research projects on needs assessment, prevention, and optimization of care of women with obstetrical and iatrogenic fistulae in Uganda. Additionally, each fellow has the freedom to engage in research ranging from basic science to clinical trials conducted at UCSF. Currently, our division has three urogynecologists and two nurse practioners, offering a robust volume and variety of clinical/surgical and research opportunities to our fellows.
Off-service Rotations
Transgender Rotation
Kaiser Permanente San Francisco serves as the Northern California hub for multidisciplinary care for transgender patients. While on rotation, you will work in the Gender Pathways Clinic, where transgender and gender-expansive patients receive integrated care in a comfortable, supportive setting. Clinical care includes hormone therapy, metal health services, surgical evaluations, and gender reaffirming and reconstructive surgery.
Chronic Pelvic Pain and Physical Therapy Rotation
During their training, fellows have the opportunity to work with a fellowship-trained sub-specialists in Female Chronic Pelvic Pain and Vulvovaginal Disorders, thus deepening their management skill set, from differential diagnosis to alternative, pharmacologic, procedural, and surgical treatment modalities. Kaiser Permanente East Bay serves as the clinical hub for this rotation.
Colorectal Surgery
During this rotation, fellows work directly with colorectal surgeons in the operating room, in the office, and in the UCSF Center for Pelvic Physiology. The emphasis is on conservative and surgical treatment of defecatory dysfunction, constipation, rectal prolapse, as well as anal dysplasia and cancer. UCSF serves as the clinical hub for this rotation.
Pediatric and Adolescent Gynecology
Fellows participate in the surgical and perioperative care of patients with congenital and acquired genital tract anomalies, including resection of complex vaginal septa, buccal grafts, and creation of neovagina. Kaiser Permanente East Bay serves as the clinical hub for this rotation.
Kaiser Permanente Sacramento Urogynecology
Fellows spend two months (one in the second year and one in the third year) on the Urogynecology service at the busiest surgical hub in KP Northern California. During this rotation, the fellow’s time is divided among the operating room and the procedure suite, where they have high volume exposure to a wide variety of pelvic reconstructive surgery cases.
Research
We strongly believe that training skilled surgeon-scientists is essential to ensuring high-quality care for women with pelvic floor disorders and place a high priority on our fellows’ research education.
As a concentrated introduction to clinical research methods, each fellow will spend 6 weeks during the summer of the first year in the Training in Clinical Research seminar at UCSF. Additionally, we have a longitudinal didactic and practical research curriculum that calls on each fellow to present research proposals, develop them into study designs, and carry out the studies. It is our expectation that each fellow will lead and participate in multiple high-quality research studies that result in presentations and publications. The fellow, together with the research mentor, will identify the study that will serve as the research thesis for the oral board examination in FPMRS.
Extensive research mentorship and support is available to our fellows, both through the research infrastructure of UCSF, as well as through Kaiser Permantente’s Division of Research.
Education
The program’s educational curriculum reflects a commitment to the interdisciplinary, team-based approach. In addition to close collaboration in the clinics and operating room, faculty, fellows, residents, and other pelvic floor health care providers meet weekly for academic conferences that follow a longitudinal didactic curriculum in FPMRS and incorporate case-based learning, journal club, scientific writing, and research works-in-progress.
Fellowship Didactics
Every Tuesday afternoon fellows are expected to participate in fellow-level conferences that include didactic lecture, preoperative case-based conference, as well as journal clubs, simulation training, cadaver dissections, or multidisciplinary roundtable discussions.
Departmental Conferences
Fellows are encouraged to participate in departmental M&M and Grand Rounds conferences at KPEB and UCSF, depending on their rotation.
Teaching Conferences
To develop their own teaching skills, the fellows participate in resident core lecture program in FPMRS within the departments of OB/Gyn and Urology. Fellows also serve as teachers during simulation and skills labs. These programs are offered throughout the academic year.
Scientific Meetings
Fellows are expected to attend the American Urogynecologic Society meeting annually. They are financially supported to attend additional regional or national meetings at which they have a presenter role. Our fellows take part in the Annual Resident Research Symposium for Kaiser Permanente Northern California as well as the UCSF Fellows Research Day.
Community and Global Health
Our program exists within two organizations that are committed to reducing healthcare disparities locally and globally. During training, each fellow will be encouraged to participate in a quality improvement project that reflects the fellow’s personal interests and/or the priorities of the Division. Fellows will also have opportunities for global health work within UCSF and Kaiser Permanente, as well as medical Spanish workshops and community surgical outreach.
The FPMRS Division and OB/Gyn department at UCSF are active in clinical care of fistula patients in Rwanda and have ongoing NIH-funded research projects on needs assessment, prevention, and optimization of care of women with obstetrical and iatrogenic fistulae in Uganda. At present the team involved in this work includes Dr. Alison El-Ayadi, who has devoted her career to obstetric fistula research and Dr. Abner Korn, who has participated in clinical and research projects on lower genital tract fistula in East Africa since 2010. This work is done in collaboration with East African colleagues, including those at Makerere University School of Medicine and Mulago National Hospital in Uganda and the Ministry of Health and Kibagabaga Hospital in Rwanda.
