Obstetrics and Gynecology

Curriculum

The educational objectives of the female pelvic medicine and reconstructive surgery fellowship program are accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching and didactic conferences. The program does not rely on fellows to fulfill non-physician service, moonlighting, or general obstetrics and gynecology night call to cover salaries.

Of the 36 months of training, 24 months are devoted to female pelvic medicine and reconstructive surgery. According to the American Board of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery fellows who were trained in OB-GYN are required to have at least 12 months of research completed in 12 one-month blocks with no more than four hours per week (averaged over four weeks) spent in non-research activities. This includes all non-research related clinical activities. Therefore, each fellow has eight months of clinical service and four months of research time for each of three consecutive academic years as outlined in the table below.

PGY567
JulyFPMRSResearchFPMRS
AugFPMRSFPMRSResearch
SeptFPMRSResearchFPMRS
OctResearchFPMRSFPMRS
NovFPMRSFPMRSResearch
DecResearchFPMRSFPMRS
JanFPMRSFPMRSResearch
FebResearchResearchFPMRS
MarFPMRSFPMRSResearch
AprResearchFPMRSFPMRS
MayFPMRSUrologyResearch
JuneFPMRSUrologyFPMRS

Didactic Sessions

The female pelvic medicine and reconstructive surgery fellowship training program includes regularly scheduled journal clubs, case/urodynamic/surgical video seminars, didactic lectures and morbidity/mortality conferences consistent with Accreditation Council for Graduate Medical Education (ACGME) program requirements as follows.

WeekDayConferenceDescription
1FridayDidactic Lecture PGY5PGY5 is responsible for a PowerPoint presentation of 11 of the 22 learning objectives outlined in the ABOG Guide to Learning for FPMRS. Therefore the entire guide is covered by didactic lectures as part of the curricula over a two-year cycle.
2FridayCase/ Urodyn /VideoInteresting patient cases, urodynamic or cystoscopic evaluations are reviewed to supplement didactic education. Surgical videos are reviewed to expand the breadth of experience guided by ACGME general competencies.
3FridayResearch MeetingForum for discussion of new, innovative research ideas, progress reports for ongoing industry and investigator initiated research projects and advisory consultations for research design, IRB submission, and data collection/analysis.
4FridayJournal ClubEach fellow is responsible for the scientific review and evaluation of a published FPMRS specific peer review journal article chosen by the program director.
5FridayMorbidity/MortalityReview patient cases associated with complications related primarily to surgical intervention.

Scholarly Activity

The fellowship program allocates adequate educational resources to facilitate fellows’ involvement in scholarly activity. According to ACGME program requirements for the female pelvic medicine and reconstructive surgery fellowship, each fellow, under the direction of a faculty mentor, must complete a comprehensive written scholarly paper or quality improvement project (thesis) during the program that demonstrates utilization of advanced research methodology and techniques, including research design and quantitative analysis, collection and statistical analysis of information obtained from a structured basic laboratory and/or clinical research setting and synthesis of the scientific literature, hypothesis testing and description of findings and results. Each PGY 7 fellow must give an oral presentation of an original scholarly project (thesis), which is formally assessed by the faculty.

According to the American Board of Obstetrics and Gynecology Bulletin for Subspecialty Certification in Female Pelvic Medicine and Reconstructive Surgery, documentation of publication or acceptance for publication by a referred journal must be submitted with the thesis to meet the requirements for application to the oral board examination. Publication or acceptance of a thesis for publication by a refereed journal does not guarantee acceptance of the thesis for the oral examination.

Research Training

The Department of Obstetrics and Gynecology is committed to developing well-educated clinical investigators with knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients and applied to patient care. This knowledge is developed by each fellow’s participation in the Clinical Investigation and Translational Education (CITE) Program in anticipation of graduation with a Master of Science in Clinical Research degree. Coursework begins in the PGY 6 year.

This program also has clinical and laboratory research facilities equipped to allow fellows to engage in scholarly activities of their choosing.

Local resourceLocationDescription
Indiana Clinical and Translational Sciences Institute (ICTSI)IndianapolisIndiana CTSI is a National Institutes of Health (NIH) and state-funded collaboration between IU School of Medicine, Purdue University and University of Notre Dame to facilitate the translation of scientific discoveries in the lab into clinical trials and new patient treatments.
Regenstrief InstituteIndianapolisRegenstrief is an internationally respected informatics and healthcare research organization affiliated with IU School of Medicine, recognized for its role in improving quality of care, increasing efficiency of healthcare delivery, preventing medical errors and enhancing patient safety.
Kinsey Institute for Research in Sex, Gender, and ReproductionBloomingtonThe Kinsey Institute promotes interdisciplinary research and scholarship in the fields of human sex, gender and reproduction.
Weldon School of Biomedical Engineering – Engineered Biomaterials and Tissue SystemsWest LafayetteEngineered biomaterial research focuses on a wide range of natural and synthetic components that might be used to design novel devices to replace diseased or damaged tissues or create artificial joints. Tissue engineering research focuses on techniques to provide replacement tissues and/or the construction of scaffolds that can allow the body to heal itself.

Publications

Faculty and fellows in this program publish their research findings in various journals and reviews. Below is a listing of past publications from 2013-2018.

Arunachalam D, Heit MH. Low Bladder Compliance in Women: A Clinical Review Female Pelvic Med Reconstr Surg. 2018 Dec 5. doi: 10.1097/SPV.0000000000000666. [Epub ahead of print] PMID:30520742

Heit MH, Carpenter JS, Chen CX, Stewart R, Hamner J, Rand KL.  Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study. Female Pelvic Med Reconstr Surg. 2018 Jun 19. doi: 10.1097/SPV.0000000000000599. [Epub ahead of print]

Powell CR, Tachibana I, Eckrich B, Rothenberg J, Hathaway J. Robotic Sacral Colpopexy.

J Endourol. 2018 May;32(S1):S111-S116.

Powell CR. Editorial Comment. J Urol. 2018 Jul;200(1):160.

Touza KK, Rand KL, Carpenter JS, Chen CX, Heit MH. A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg. 2018 Mar 5. doi: 10.1097/SPV.0000000000000578. [Epub ahead of print] PubMed PMID: 29509647.

Arunachalam D, Hale DS, Heit MH. Posterior Compartment Surgery Provides No Differential Benefit for Defecatory Symptoms Before or After Concomitant Mesh-Augmented Apical Suspension. Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):183-187. doi: 10.1097/SPV.0000000000000538. PubMed PMID: 29319557.

Stewart JR, Heit MH, Meriwether KV, Hobson DT, Francis SL. Analyzing the Readability of Online Urogynecologic Patient Information. Female Pelvic Med Reconstr Surg. 2017 Nov 7. doi: 10.1097/SPV.0000000000000518. [Epub ahead of print] PubMed PMID: 29117016.

Jaqua K, Powell CR. Where Are We Headed with Neuromodulation for Overactive Bladder?

Curr Urol Rep. 2017 Aug;18(8):59.

Thomas DE, Kaimakliotis HZ, Rice KR, Pereira JA, Johnston P, Moore ML, Reed A, Cregar DM, Franklin C, Loman RL, Koch MO, Bihrle R, Foster RS, Masterson TA, Gardner TA, Sundaram CP, Powell CR, Beck SDW, Grignon DJ, Cheng L, Albany C, Hahn NM. Prognostic Effect of Carcinoma In Situ in Muscle-invasive Urothelial Carcinoma Patients Receiving Neoadjuvant Chemotherapy.

Clin Genitourin Cancer. 2017 Aug;15(4):479-486. doi: 10.1016/j.clgc.2016.11.009. Epub 2016 Nov 30.

Hale DS.  The American Urogynecologic Society 2016 Annual Scientific Meeting Presidential Address: When You Come to a Fork in the Road… Female Pelvic Med Reconstr Surg. 2017 Mar/Apr;23(2):65-71. doi: 10.1097/SPV.0000000000000383. No abstract available.PMID: 28145914

Durst PJ, Heit MH. Polypropylene Mesh Predicts Mesh/Suture Exposure After Sacrocolpopexy Independent of Known Risk Factors: A Retrospective Case-Control Study. Female Pelvic Med Reconstr Surg. 2017 Jun 27. doi: 10.1097/SPV.0000000000000452. [Epub ahead of print] PubMed PMID: 28657987.

James-Stevenson T, Xu H, Heit M, Shin A. Age and Dyssynergia Subtypes Associated With Normal Sphincter Pressures in Women With Fecal Incontinence. Female Pelvic Med Reconstr Surg. 2017 Jun 27. doi: 10.1097/SPV.0000000000000415. [Epub ahead of print] PubMed PMID: 28657991.

Ju R, Siddiqui N, Garrett J, Feng L, Heit M. A validated translation of a survey for measuring incontinence knowledge in Chinese-speaking American immigrants. Int Urogynecol J. 2017 Jun;28(6):851-856. doi: 10.1007/s00192-016-3215-1. Epub 2016 Dec 6. PubMed PMID: 27924375.

Takase-Sanchez MM, Thompson JC, Hale DS, Heit MH. Suprapubic versus transurethral bladder drainage following reconstructive pelvic surgery: a comparison of patient satisfaction and quality of life. Int Urogynecol J. 2017 May;28(5):721-728. doi: 10.1007/s00192-016-3164-8. Epub 2016 Oct 6. PubMed PMID: 27714436.

Heit M, Guirguis N, Kassis N, Takase-Sanchez M, Carpenter J. Operationalizing the Measurement of Socioeconomic Position in Our Urogynecology Study Populations: An Illustrative Review. Female Pelvic Med Reconstr Surg. 2017 May/Jun;23(3):208-215. doi: 10.1097/SPV.0000000000000353. Review. PubMed PMID: 27782979.

Carpenter JS, Heit M, Rand KL. Development and psychometric properties of a measure of catheter burden with bladder drainage after pelvic reconstructive surgery. Neurourol Urodyn. 2017 Apr;36(4):1140-1146. doi: 10.1002/nau.23077. Epub 2016 Jul 26. PubMed PMID: 27460055.

Khoder W, Hom E, Guanzon A, Rose S, Hale D, Heit M. Patient satisfaction and regret with decision differ between outcomes in the composite definition of success after reconstructive surgery. Int Urogynecol J. 2017 Apr;28(4):613-620. doi: 10.1007/s00192-016-3157-7. Epub 2016 Oct 13. PubMed PMID: 27738734.

Carpenter JS, Heit M, Chen CX, Stewart R, Hamner J, Rand KL. Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2017 Mar/Apr;23(2):86-89. doi: 10.1097/SPV.0000000000000352. PubMed PMID: 28230616.

Kassis NC, Hamner JJ, Takase-Sanchez MM, Khoder W, Hale DS, Heit MH. If you could see what we see, would it bother you? Int Urogynecol J. 2017 Jan;28(1):59-64. doi: 10.1007/s00192-016-3073-x. Epub 2016 Jul 2. PubMed PMID: 27372947.

Fenner D, Hale D. Reply. Am J Obstet Gynecol. 2016 Sep;215(3):397-8. doi: 10.1016/j.ajog.2016.04.030. Epub 2016 Apr 26. No abstract available. PMID: 27130237

Kim A, Powell CR, Ziaie B An Universal packaging technique for low-drift implantable pressure sensors.Biomed Microdevices. 2016 Apr;18(2):32.

Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol. 2016 Feb;5(1):12-21.

Stewart JR, Hamner JJ, Heit MH. Thirty Years of Cystocele/Rectocele Repair in the United States. Female Pelvic Med Reconstr Surg. 2016 Jul-Aug;22(4):243-7. doi: 10.1097/SPV.0000000000000240. PubMed PMID: 26825407.

Hale DS. Pay for Performance-Are You Prepared? Female Pelvic Med Reconstr Surg. 2016 May-Jun;22(3):123-5.

Varma MG, Matthews CA, Muir T, Takase-Sanchez MM, Hale DS, Van Drie D, Richter HE. Impact of a Novel Vaginal Bowel Control System on Bowel Function. Dis Colon Rectum. 2016 Feb;59(2):127-31. doi: 10.1097/DCR.0000000000000517. PMID: 26734971

Takase-Sanchez MM, Brooks HM, Hale DS, Heit MH. Obliterative Surgery for the Treatment of Pelvic Organ Prolapse: A Patient Survey on Reasons for Surgery Selection and Postoperative Decision Regret and Satisfaction. Female Pelvic Med Reconstr Surg. 2015 Nov-Dec;21(6):325-31. doi: 10.1097/SPV.0000000000000198. PubMed PMID: 26506160.

Flack CK, Monn MF, Patel NB, Gardner TA, Powell CR.  National Trends in the Performance of Robot-Assisted Sacral Colpopexy. J Endourol. 2015 Jul;29(7):777-83. doi: 10.1089/end.2014.0710. Epub 2015 Mar 10.

Kassis NC, Wo JM, James-Stevenson TN, Maglinte DD, Heit MH, Hale DS. Balloon expulsion testing for the diagnosis of dyssynergic defecation in women with chronic constipation. Int Urogynecol J. 2015 Sep;26(9):1385-90. doi: 10.1007/s00192-015-2722-9. Epub 2015 Jun 18. PubMed PMID: 26085464.

Guirguis N, Heit MH. Urinary Biomarkers Under Investigation for Overactive Bladder Syndrome. Current bladder dysfunction reports. 2015; 2:1-5.

Hale DS, Fenner D. Consistently inconsistent, the posterior vaginal wall. Am J Obstet Gynecol. 2016 Mar;214(3):314-20. doi: 10.1016/j.ajog.2015.09.001. Epub 2015 Sep 5. Review. PMID: 26348375

Richter HE, Matthews CA, Muir T, Takase-Sanchez MM, Hale DS, Van Drie D, Varma MG. A vaginal bowel-control system for the treatment of fecal incontinence. Obstet Gynecol. 2015 Mar;125(3):540-7. doi: 10.1097/AOG.0000000000000639. PMID: 25730213

Kassis NC, Thompson JC, Scheidler AM, Daggy JK, Hale DS. Documentation of specific mesh implant at the time of midurethral sling surgery in women with stress incontinence. Female Pelvic Med Reconstr Surg. 2015 Jan-Feb;21(1):43-5. doi: 10.1097/SPV.0000000000000106. PMID: 25185626

Heit M. In reply. Obstet Gynecol. 2014 Apr;123(4):888-9. doi: 10.1097/AOG.0000000000000200. PubMed PMID: 24785628.

Heit M. Surgical proctoring for gynecologic surgery. Obstet Gynecol. 2014 Feb;123(2 Pt 1):349-52. doi: 10.1097/AOG.0000000000000076. PubMed PMID: 24402592.

Khoder W, Hale D. Pudendal neuralgia. Obstet Gynecol Clin North Am. 2014 Sep;41(3):443-52. doi: 10.1016/j.ogc.2014.04.002. Epub 2014 Jul 9. Review. PMID: 25155124

George A, Mattingly M, Woodman P, Hale D. Recurrence of prolapse after transvaginal mesh excision.Female Pelvic Med Reconstr Surg. 2013 Jul-Aug;19(4):202-5.

McDermott CD, Park J, Terry CL, Woodman PJ, Hale DS. Sacral colpopexy versus transvaginal mesh colpopexy in obese patients. J Obstet Gynaecol Can. 2013 May;35(5):461-467.

Iglesia CB, Hale DS, Lucente VR. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse. Int Urogynecol J. 2013 Mar;24(3):363-70.

George A, Hensley A, Hale D. Pelvic surgeons be aware: Ogilvie’s syndrome (a case report).

Int Urogynecol J. 2013 Apr;24(4):693-6.

Maglinte DD, Hale DS, Sandrasegaran K.  Comparison between dynamic cystocolpoproctography and dynamic pelvic floor MRI: pros and cons: which is the “functional” examination for anorectal and pelvic floor dysfunction? Abdom Imaging. 2013 Oct;38(5):952-73.